There are a number of reasons for this discrepancy of data. No accurate records are kept concerning office emergencies, so occurrence rates depend on physician recall which is difficult and at best guesswork. There can be clear differences of opinion as well, i.e. one person's asthma emergency is another's routine asthma visit. There are also many types of office practices - solo, group, multi-specialty, hospital-based, rural, urban - and these factors all influence the frequency of emergencies seen.
In spite of the above, this may be a situation where we really don't need "more studies". Even if office emergencies seldom occur, when they do, they must be dealt with efficiently and competently. Data available on trauma and cardiac arrest victims clearly shows that effective early treatment yields better outcomes. Studies also consistently show that patients treated as part of a systematic protocol have better outcomes, regardless of the details of the protocol. As I always say, 'You have to have a plan. It doesn't have to be the right one, because you can always change it. But you have to have a plan.'
Guidelines have been published concerning emergency equipment and medications recommended for pediatric offices. However the literature shows poor compliance with these guidelines. While more than 70% of pediatrician's offices have such basic emergency supplies as oxygen, bag and mask, 1:1000 epinephrine and IV equipment, only 50% have endotracheal tubes and laryngoscopes. Less than half have defibrillators, cardiac monitors, EKG machines, 1:10,000 epinephrine or intraosseous needles. In general, solo practices have less equipment than group practices and practitioners who are PALS certified have more equipment. Studies have also documented poor compliance with suggested office emergency training. Less than 20% of eligible office staff are either BLS or PALS certified.