The Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) is committed to collecting and disseminating high-quality data that meet the information needs of a wide range of users. We take issue with the unfavorable assessment of National Hospital Ambulatory Medical Care Survey (NHAMCS) data in a recent editorial by Cooper1 and appreciate the opportunity to respond to her comments. | We agree with Cooper1 that research findings need to be critically assessed, and we appreciate the guidelines she provides for potential authors using NHAMCS data, which are consistent with our recent article.2 We are troubled, however, by her sweeping indictment of the NHAMCS data-gathering process and her concern that medical practice or policy may have changed based on “the false assumption that the data were valid.”1 In fact, the authors cited by Cooper1 appropriately assessed the limitations of using NHAMCS data3, 4, 5, 6 and reported that their findings3, 4, 5 were consistent with previous research. In cases in which findings from studies diverge, it is important to consider the methodology of each study. A particular strength of NHAMCS is that it includes hospitals other than academic medical centers, which commonly serve as the settings for research studies, thereby giving a more complete picture of health care use patterns. When comparing data from NHAMCS with other studies, one should always be careful to keep such methodological differences in mind before making conclusions about validity.

The National Hospital Ambulatory Medical Care Survey (NHAMCS) is widely used for medical research. Nearly 500 articles have been published based on this database, including 28 in Annals of Emergency Medicine. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments in nonfederal, general, and short-stay hospitals, conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics (http://www.cdc.gov/nchs/ahcd.htm). Strengths of the NHAMCS survey are its rigorous methodology, nationally representative nature, large size, wide array of variables, and capacity to examine long-term trends. Investigators can freely download the database and test locally developed hypotheses. Challenges with NHAMCS are that, given its logistic and statistical complexity, resulting research can be difficult for readers to interpret and for editors and reviewers to critique. There are important limitations and caveats to this survey that, if overlooked, could lead to misleading or inaccurate conclusions. In this article, we have a posed a series of questions to 2 NHAMCS statisticians, and we believe that their answers will be invaluable to both NHAMCS investigators and readers of its research.

Children who require emergency care have unique needs, especially when emergencies are serious or life-threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. This statement outlines resources necessary to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents. These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the Academic Pediatric Association, American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Pediatric Surgical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, Society for Academic Emergency Medicine, and The Joint Commission.

Using data from the National Ambulatory Medical Care Survey, logit models tested for trends in the probability that visits by adult diabetes patients to their primary care providers included recommended treatment measures, such as a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB), blood pressure measurement, and diet/nutrition or exercise counseling. Results indicated that the probability that visits included prescription of an ACE or ARB and blood pressure measurement increased significantly over the 1997-2005 period, while the probability that visits documented provision of exercise counseling rose since 2001.