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Ma K, Ali S, Xie J, Maki C, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi O, Poonai N, MacDonald SE, Tarr P, Freedman SB. Characterizing the Pain Experience of Children With Acute Gastroenteritis Based on Identified Pathogens. J Pediatr Gastroenterol Nutr 2023; 76:160-165. [PMID: 36705697 DOI: 10.1097/mpg.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Pain is common with acute gastroenteritis (AGE) yet little is known about the severity associated with specific enteropathogens. We sought to explore the correlation of pain severity with specific enteropathogens in children with AGE. METHODS Participants were prospectively recruited by the Alberta Provincial Pediatric EnTeric Infection TEam at 2 pediatric emergency departments (EDs) (December 2014-August 2018). Pain was measured (by child and/or caregiver) using the 11-point Verbal Numerical Rating Scale. RESULTS We recruited 2686 participants; 46.8% (n = 1256) females, with median age 20.1 months (interquartile range 10.3, 45.3). The mean highest pain scores were 5.5 [standard deviation (SD) 3.0] and 4.2 (SD 2.9) in the 24 hours preceding the ED visit, and in the ED, respectively. Prior to ED visit, the mean highest pain scores with bacterial detection were 6.6 (SD 2.5), compared to 5.5 (SD 2.9) for single virus and 5.5 (SD 3.1) for negative stool tests. In the ED, the mean highest pain scores with bacterial detection were 5.5 (SD 2.7), compared to 4.1 (SD 2.9) for single virus and 4.2 (SD 3.0) for negative stool tests. Using multivariable modeling, factors associated with greater pain severity prior to ED visit included older age, fever, illness duration, number of diarrheal or vomiting episodes in the preceding 24 hours, and respiratory symptoms, but not enteropathogen type. CONCLUSION Children with AGE experience significant pain, particularly when the episode is associated with the presence of a bacterial enteric pathogen. However, older age and fever appear to influence children's pain experiences more than etiologic pathogens.
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Affiliation(s)
- Keon Ma
- From the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samina Ali
- the Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Women & Children's Health Research Institute (WCHRI), Edmonton, Canada
| | - Jianling Xie
- the Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Claudia Maki
- the Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Bonita Lee
- the Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Women & Children's Health Research Institute (WCHRI), Edmonton, Canada
| | - Linda Chui
- the Alberta Precision Laboratories-ProvLab, Edmonton, Canada
- the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Xiao-Li Pang
- the Alberta Precision Laboratories-ProvLab, Edmonton, Canada
- the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Ran Zhuo
- the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Brendon Parsons
- the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Otto Vanderkooi
- the Department of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Naveen Poonai
- the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Shannon E MacDonald
- the Faculty of Nursing, University of Alberta, Edmonton, Canada
- the Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Phillip Tarr
- the Division of Gastroenterology, Washington University, St. Louis, MO, USA
| | - Stephen B Freedman
- the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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2
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Hollaway W, Borland ML. Return visits to the paediatric emergency department. Emerg Med Australas 2022; 34:584-589. [PMID: 35322579 DOI: 10.1111/1742-6723.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the rate of unplanned return visits (uRVs) within 48 h to a paediatric ED over a 12-month period and describe the factors associated with these uRV. METHODS Retrospective review of electronic data regarding the initial and follow-up visit at a tertiary paediatric hospital ED in Western Australia. The primary outcome was the number of patients who presented for uRV within 48 h of their initial ED visit. RESULTS Between August 2018 and July 2019, 2322 patients returned to the ED for a uRV comprising 3.4% of 68 352 ED presentations with more than 53% returning with infectious causes. Triage category 3 patients were most likely to represent (OR 1.11, P = 0.029) with 3-month to 1-year old (OR 1.37, P < 0.00001) and 1-5-year old (OR 1.32, P < 0.00001) the commonest age groups. There was seasonal variation in uRVs demonstrating a greater number in the winter months. The percentage of uRVs to overall ED presentations was greater in the summer months (3.8-4.1%). There was a significant increase in uRVs occurring up to 2 weeks after the changeovers in middle-grade ED doctors only. CONCLUSIONS The present study has demonstrated associations between uRV and initial-visit triage category 3, age between 3 months and 5 years, and presentations because of infectious illness. Middle-grade doctor changeover was also associated with an increase in uRVs.
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Affiliation(s)
- William Hollaway
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Health and Medical Sciences (Pediatrics and Emergency Medicine), The University of Western Australia, Perth, Western Australia, Australia
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Kurt F, Hanalioğlu D, Can F, Kurtipek FE, Yakut Hİ, Misirlioğlu ED. Evaluation of Unscheduled Return Visits to the Pediatric Emergency Department and Risk Factors for Admission After Return Visit. Pediatr Emerg Care 2022; 38:e967-e972. [PMID: 34314393 DOI: 10.1097/pec.0000000000002504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Unscheduled return visits to the emergency department (unscheduled RTED) increase both the workload and overcrowding in the emergency department. The aim in the present study is to identify the patient groups that require more careful and closer follow-up to reduce the rates of unscheduled RTED and hospital admissions after a return visit. METHODS Among the patients admitted to the emergency department of our hospital between 2016 and 2017, those who made an unscheduled RTED within 72 hours after their first visit to the emergency department were evaluated retrospectively. RESULTS Of the 137,787 eligible children, 3294 (2.8%) made unscheduled RTEDs within 72 hours. The median age was 28 months, and 1848 (57.6%) were male patients. The admission rate at the return visit was significantly higher among children younger than 2 years, in the patients presenting with respiratory complaints and severe acute conditions, and in those who presented to the emergency department for the first time during the department's busiest hours. The risk of admission upon a return visit to the emergency department was 2.7 times higher in the male sex, 5.4 times higher in children younger than 2 years, 5.9 times higher in patients with respiratory complaints, 4.9 times higher in patients with gastrointestinal tract complaints, and 27,000 times higher in patients with severe acute conditions. CONCLUSIONS Unscheduled RTED and hospitalization rates can be reduced with more careful evaluation of young children, patients with respiratory and gastrointestinal complaints and those who apply during emergency department busiest hours.
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Affiliation(s)
- Funda Kurt
- From the Division of Pediatric Emergency Medicine, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences
| | - Damla Hanalioğlu
- Division of Pediatric Emergency Medicine, Hacettepe University Faculty of Medicine
| | - Fatmanur Can
- Department of Pediatrics, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatma Eren Kurtipek
- Department of Pediatrics, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halil İbrahim Yakut
- From the Division of Pediatric Emergency Medicine, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences
| | - Emine Dibek Misirlioğlu
- From the Division of Pediatric Emergency Medicine, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences
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Jankauskaite L, Grechukha Y, Kjær KA, Mamenko M, Nakstad B, Romankevych I, Schnyder S, Selvakumar J, Trapani S, Daniliaviciene S, Valiulis A, Wyder C, Størdal K. Overuse of medical care in paediatrics: A survey from five countries in the European Academy of Pediatrics. Front Pediatr 2022; 10:945540. [PMID: 36177454 PMCID: PMC9513058 DOI: 10.3389/fped.2022.945540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Studies and initiatives such as the "Choosing wisely" (CW) campaign emphasise evidence-based investigations and treatment to avoid overdiagnosis and overtreatment. The perception of the extent of medical overactivity among professionals and drivers behind are not well studied in the paediatric field. AIM We aimed to investigate the physicians' opinion and clarify the main drivers regarding medical overactivity in member countries of the European Academy of Paediatrics (EAP). METHODS In this study, paediatricians, paediatric residents, primary care paediatricians, and family doctors treating children were surveyed in Norway, Lithuania, Ukraine, Italy, and Switzerland. Over-investigation was defined as "diagnostic work-up or referral that is unlikely to provide information which is relevant for a patient" and overtreatment was defined as "treatment that does not benefit or can harm more than benefit the patient." The original questionnaire was developed in 2018 by a working group from the Norwegian Paediatric Association. RESULTS Overall, 1,416 medical doctors participated in the survey, ranging from 144 in Lithuania to 337 in Switzerland. 83% stated that they experienced over-investigation/overtreatment, and 81% perceived this as a problem. The majority (83%) perceived expectations from family and patients as the most important driver for overtreatment in their country. Other drivers for overuse were use of national guidelines/recommendations, worry for reactions, and reduction of uncertainty. CONCLUSION This is the first study investigating knowledge and attitude toward medical overactivity in European countries. Despite different cultural and economic environments, the patterns and drivers of increased investigations and medicalisation are similar.
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Affiliation(s)
- Lina Jankauskaite
- Department of Paediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,European Academy of Paediatrics, Brussels, Belgium
| | - Yevgenii Grechukha
- European Academy of Paediatrics, Brussels, Belgium.,Department of Paediatric Infectious Diseases and Paediatric Immunology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | | | - Marina Mamenko
- European Academy of Paediatrics, Brussels, Belgium.,Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine.,Ukrainian Academy of Paediatric Specialties, Kyiv, Ukraine
| | - Britt Nakstad
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Ivanna Romankevych
- European Academy of Paediatrics, Brussels, Belgium.,Ukrainian Academy of Paediatric Specialties, Kyiv, Ukraine.,Miller School of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, FL, United States
| | - Sara Schnyder
- European Academy of Paediatrics, Brussels, Belgium.,Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel Selvakumar
- Department of Paediatric and Adolescent Health, Akershus University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sandra Trapani
- European Academy of Paediatrics, Brussels, Belgium.,Paediatric Unit, Department of Health Sciences, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sandra Daniliaviciene
- Karoliniskiu Policlinic, Vilnius, Lithuania.,Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Arunas Valiulis
- European Academy of Paediatrics, Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.,Human Ecology Research Group, Department of Public Health, Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Corinne Wyder
- European Academy of Paediatrics, Brussels, Belgium.,Paediatric Praxis Kurwerk, Burgdorf, Switzerland
| | - Ketil Størdal
- European Academy of Paediatrics, Brussels, Belgium.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Department of Paediatric Research, University of Oslo, Oslo, Norway
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Portillo EN, Stack AM, Monuteaux MC, Curt A, Perron C, Lee LK. Association of limited English proficiency and increased pediatric emergency department revisits. Acad Emerg Med 2021; 28:1001-1011. [PMID: 34431157 DOI: 10.1111/acem.14359] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/12/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Limited English proficiency (LEP) is a risk factor for health care inequity and an important focus for improving communication and care quality. This study examines the association between LEP and pediatric emergency department (ED) revisits. METHODS This was a retrospective, cross-sectional study of patients 0 to 21 years old discharged home after an initial visit from an academic, tertiary care pediatric ED from January 1, 2017, to June 30, 2018. We calculated rates of ED revisits within 72 h resulting in discharge or hospitalization and assessed rate differences between LEP and English-proficient (EP) patients. Multivariable logistic regression models examined the association between revisits and LEP status controlling for age, race, ethnicity, triage acuity, clinical complexity, and ED arrival time. Sensitivity models including insurance were also conducted. RESULTS There were 63,601 index visits in the study period; 12,986 (20%) were by patients with LEP. There were 2,387 (3.8%) revisits within 72 h of initial ED visit. Among LEP and EP patient visits, there were 4.53 and 3.55 revisits/100 initial ED visits, respectively (rate difference = 0.97, 95% confidence interval [CI] = 0.58 to 1.37). In the multivariable analyses, LEP was associated with increased odds of revisits resulting in discharge (odds ratio [OR] = 1.15, 95% CI = 1.01 to 1.30) and in hospitalization (OR = 1.28, 95% CI = 1.03 to 1.58). Sensitivity analyses additionally adjusting for insurance status attenuated these results. CONCLUSIONS These results suggest that LEP was associated with increased pediatric ED revisits. Improved understanding of language barrier effects on clinical care is important for decreasing health care disparities in the ED.
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Affiliation(s)
- Elyse N. Portillo
- Section of Emergency Medicine Baylor College of MedicineTexas Children’s Hospital Houston Texas USA
| | - Anne M. Stack
- Division of Emergency Medicine Boston Children’s Hospital Boston Massachusetts USA
| | - Michael C. Monuteaux
- Division of Emergency Medicine Boston Children’s Hospital Boston Massachusetts USA
| | - Alexa Curt
- Division of Emergency Medicine Boston Children’s Hospital Boston Massachusetts USA
| | - Catherine Perron
- Division of Emergency Medicine Boston Children’s Hospital Boston Massachusetts USA
| | - Lois K. Lee
- Division of Emergency Medicine Boston Children’s Hospital Boston Massachusetts USA
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Rintaari KM, Kimani RW, Musembi HM, Gatimu SM. Characteristics and outcomes of patients with an unscheduled return visit within 72 hours to the Paediatric Emergency Centre at a Private Tertiary Referral Hospital in Kenya. Afr J Emerg Med 2021; 11:242-247. [PMID: 33859926 PMCID: PMC8027518 DOI: 10.1016/j.afjem.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/28/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Patients’ unscheduled return visits (URVs) to the paediatric emergency Centre (PEC) contribute to overcrowding and affect health service delivery and overall quality of care. This study assessed the characteristics and outcomes of paediatric patients with URVs (within 72 hours) to the PEC at a private tertiary hospital in Kenya. Methods We conducted a retrospective chart review of all URVs within 72 hours among paediatric patients aged ≤15 years between 1 July and 31 December 2018 at the tertiary hospital in Nairobi, Kenya. Results During the study period, 1.6% (n=172) of patients who visited the PEC returned within 72 hours, with 4.7% revisiting the PEC more than once. Patients’ median age was 36 months (interquartile range: 42 months); over half were male (51.7%), 55.8% were ambulatory and 84.3% were insured. In addition, 21% (n=36) had chronic diseases and 7% (n=12) had drug allergies. Respiratory (59.5%) and gastrointestinal (21.5%) tract infections were the most common diagnoses. Compared with the first visit, more patients with URVs were classified as urgent (1.7% vs. 5.2%) and were non-ambulatory (44.2% vs. 49.5%, p=<0.001); 18% of these patients were admitted. Of these 58% were male, 83.9% were aged 0–5 years, 12.9% were classified as urgent, 64.5% had respiratory tract infections and 16.1% had gastrointestinal tract infections. Being admitted was associated with patient acuity (p=0.004), laboratory tests (p=<0.001) and ambulatory status (p=0.041). Conclusion The URV rate is low in our setting. Patients who returned to the PEC within 72 hours tended to be male, under 5 years old and insured. Many were non-urgent cases with diagnoses of respiratory and gastrointestinal tract infections. The findings suggest that some URVs were necessary and may have contributed to better care and improved outcomes while others highlight a need for effective patient education and comprehensive initial assessment.
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Model-Based Recursive Partitioning of Patients' Return Visits to Multispecialty Clinic During the 2009 H1N1 Pandemic Influenza (pH1N1). Online J Public Health Inform 2020; 12:e4. [PMID: 32577153 DOI: 10.5210/ojphi.v12i1.10576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background During the 2009 H1N1 influenza pandemic (pH1N1), the proportion of outpatient visits to emergency departments, clinics and hospitals became elevated especially during the early months of the pandemic due to surges in sick, 'worried well' or returning patients seeking care. We determined the prevalence of return visits to a multispecialty clinic during the 2009 H1N1 influenza pandemic and identify subgroups at risk for return visits using model-based recursive partitioning technique. Methods This study was a retrospective analysis of ILI-related medical care visits to multispecialty clinic in Houston, Texas obtained as part of the Houston Health Department Influenza Sentinel Surveillance Project (ISSP) during the 2009 H1N1 pandemic influenza (April 2009 - March 2010). The data comprised of 2680 individuals who made a total of 2960 clinic visits. Return visit was defined as any visit following the index visit after the wash-out phase prior to the study period. We applied nominal logistic regression and recursive partitioning models to determine the independent predictors and the response probabilities of return visits. The sensitivity and specificity of the outcomes probabilities were determined using receiver operating characteristic (ROC) curve. Results Overall, 4.56% (Prob. 0.0%-17.5%) of the cohort had return visits with significant variations observed attributed to age group (76.0%), type of vaccine received by patients (18.4%) and Influenza A (pH1N1) test result (5.6%). Patients in age group 0-4 years were 9 times (aOR: 8.77, 95%CI: 3.39-29.95, p<0.0001) more likely than those who were 50+ years to have return visits. Similarly, patients who received either seasonal flu (aOR: 1.59, 95% CI 1.01-2.50, p=0.047) or pH1N1 (aOR: 1.74, 95%CI: 1.09-2.75, p=0.022) vaccines were about twice more likely to have return visits compared to those with no vaccination history. Model-based recursive partitioning yielded 19 splits with patients in subgroup I (patients of age group 0-4 years, who tested positive for pH1N1, and received both seasonal flu and pH1N1 vaccines) having the highest risk of return visits (Prob.=17.5%). The area under the curve (AUC) for both return and non-return visits was 72.9%, indicating a fairly accurate classification of the two groups. Conclusions Return visits in our cohort were more prevalent among children and young adults, and those that received either seasonal flu or pH1N1 or both vaccines. Understanding the dynamics in care-seeking behavior during pandemic would assist policymakers with appropriate resource allocation, and in the design of initiatives aimed at mitigating surges and recurrent utilization of the healthcare system.
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Chiang CY, Chen YL, Lin YR, Cheng FJ, Wu KH, Chiu IM. Characteristics of Febrile Children Admitted to the ICU Following an Unscheduled ED Revisit Within 72 h, a Case-Control Study. Front Pediatr 2020; 8:411. [PMID: 32850531 PMCID: PMC7426702 DOI: 10.3389/fped.2020.00411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: The purpose of this article was to demonstrate related characteristics of intensive care unit (ICU) admission after an unscheduled revisit by febrile children visiting the emergency department (ED). Method: We performed a retrospective study in a tertiary medical center from 2010 to 2016. Patients whose chief complaint was fever and who were admitted to the ICU following a 72-h return visit to the ED were included, and we selected patients who were discharged from the same emergency department for comparison. Results: During the study period, 54 (0.03%) patients met the inclusion criteria, and 216 patients were selected for the matched control group. Regarding clinical variables on initial ED visit, visiting during the night shift (66.7 vs. 46.8%, p = 0.010), shorter length of 1st ED stay (2.5 ± 2.63 vs. 3.5 ± 3.44 h, p = 0.017), and higher shock index (SI) (1.6 ± 0.07 vs. 1.4 ± 0.02, p = 0.008) were associated with ICU admission following a return visit. On the return ED visit, we found that clinical variables such as elevated heart rate, SI, white blood cell count, and C-reactive protein level were all associated with ICU admission. Furthermore, elevated SI and pediatric age-adjusted (SIPA) values were observed in the study group in both the initial (42.2 vs. 20.1%, OR:2.3 (1.37-4.31), p = 0.002) and return ED visits (29.7 vs. 6.9%, OR: 4.6 (2.42-8.26), p < 0.001). Conclusion: For children who visited the emergency department with a febrile complaint, elevated SIPA values on the initial ED visit were associated with ICU admission following an unscheduled ED revisit within 72 h.
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Affiliation(s)
- Charng-Yen Chiang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Lun Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yet-sen University, Kaohsiung, Taiwan
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9
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Chiang CY, Cheng FJ, Huang YS, Chen YL, Wu KH, Chiu IM. ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours. BMC Pediatr 2019; 19:268. [PMID: 31375075 PMCID: PMC6676510 DOI: 10.1186/s12887-019-1644-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The purpose of this study was to describe the demographic characteristics and prognosis of children admitted to the intensive care unit (ICU) after a pediatric emergency department (PED) return visit within 72 h. METHOD We conducted this retrospective study from 2010 to 2016 in the PED of a tertiary medical center in Taiwan and included patients under the age of 18 years old admitted to the ICU after a PED return visit within 72 h. Clinical characteristics were collected to perform demographic analysis. Pediatric patients who were admitted to the ICU on an initial visit were also enrolled as a comparison group for outcome analysis, including mortality, ventilator use, and length of hospital stay. RESULTS We included a total of 136 patients in this study. Their mean age was 3.3 years old, 65.4% were male, and 36.0% had Chronic Health Condition (CHC). Disease-related return (73.5%) was by far the most common reason for return. Compared to those admitted on an initial PED visit, clinical characteristics, including vital signs at triage and laboratory tests on return visit with ICU admission, demonstrated no significant differences. Regarding prognosis, ICU admission on return visit has a higher likelihood of ventilator use (aOR:2.117, 95%CI 1.021~4.387), but was not associated with increased mortality (aOR:0.658, 95%CI 0.150~2.882) or LOHS (OR:-1.853, 95%CI -4.045~0.339). CONCLUSION Patients who were admitted to the ICU on return PED visits were associated with an increased risk of ventilator use but not mortality or LOHS compared to those admitted on an initial visit.
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Affiliation(s)
- Charng-Yen Chiang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China
| | - Yi-Syun Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China
| | - Yu-Lun Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd. Niaosong Dist, Kaohsiung City, 83301, Taiwan, Republic of China.
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10
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Jadhav N, Grams K, Alweis R. Cost of a learner in pediatric ED. J Community Hosp Intern Med Perspect 2019; 9:80-85. [PMID: 31044036 PMCID: PMC6484465 DOI: 10.1080/20009666.2019.1581045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Experiential learning in a cornerstone of medical education, but impacts throughput, utilization of resources and patient outcomes. Objectives: Our study sought to determine the cost of a resident across various throughput, utilization, and patient outcome measures. Methods: This retrospective study was conducted in 2016 in the pediatric emergency department of an urban tertiary care hospital. . We compared various throughput, utilization and patient outcome measures between resident-covered and nonresident–covered patients. A subgroup analysis was performed based on complexity as determined by CPT codes. Results: 33,278 patient encounters occurred between 1 January 2016, and 31 December 2016. Of these, 8,434 (25.42%) were resident-covered patients. Across all encounters, throughput, utilization and patient experience measures were unfavorable for the resident covered group. In subgroup analysis based on complexity of patients, throughput measures were either unfavorable or there was a trend towards unfavorability across all complexities for the resident covered group. Overall utilization and patient outcome measures were unfavorable in low and moderate complexity patients for the resident covered group. In high complexity patients, most of the utilization and patient outcome measures were similar in both groups. Conclusion: Presence of a resident led to unfavorable increases in many throughput, utilization and outcome measures, a difference which disappeared in most cases with higher complexity patients. Therefore, the cost of a resident may actually decrease with increasing patient complexity.
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Affiliation(s)
- Nagesh Jadhav
- Internal medicine residency program, Rochester General Hospital, Rochester, NY, USA
| | - Keith Grams
- Emergency Medicine, Rochester Regional Health, Rochester, NY, USA
| | - Richard Alweis
- Internal Medicine, Rochester Regional Health, Rochester, NY, USA
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Judge P, Tabeshi R, Yao RJ, Meckler G, Doan Q. Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study. Paediatr Child Health 2018; 24:227-233. [PMID: 31239811 DOI: 10.1093/pch/pxy125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/28/2018] [Indexed: 11/14/2022] Open
Abstract
Background We recently introduced a clinical practice pathway for the management of asthma that uses the Pediatric Respiratory Assessment Measure (PRAM) to guide emergency department (ED) treatment and disposition. The pathway recommends discharge for patients who achieve improvement to PRAM <4 at 1 hour after the last bronchodilator. We evaluated practice variation and patient outcomes associated with PRAM-directed disposition recommendations. Methods We conducted a retrospective cohort study of children aged 2 to 17 years treated for moderate asthma (PRAM score 4-7) using our asthma clinical pathway. We measured 1) the proportion of children discharged per pathway criteria who returned to our ED within 24 hours and 2) the proportion of children observed beyond the pathway discharge criteria who deteriorated (PRAM ≥4). Results We analyzed 385 patient records from September 2013 to February 2015. Among 145 (37.7%) patients discharged per pathway criteria, 4 (4/145; 2.8%) returned within 24 hours. The remaining 240 (62.2%) were observed beyond the pathway discharge criteria; 76/240 (31.7%) had a subsequent deterioration (PRAM score ≥ 4) and 25/240 (10.4%) were hospitalized. Of those who deteriorated, 46/76 (60.5%) worsened within the first additional hour of observation. Conclusion We observed significant deviation from our PRAM-directed pathway discharge criteria and that a significant proportion of observed patients experienced clinical deterioration beyond the first hour of observation. We recommend observing children with moderate asthma for 2 or 3 hours from last bronchodilator therapy if PRAM < 4 is maintained, to capture the majority (97.7% or 99.7%) of patients who require further intervention and hospitalization.
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Affiliation(s)
- Pavan Judge
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Raymond Tabeshi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Ren Jie Yao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Garth Meckler
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Quynh Doan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
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