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Öztürk B, Güneylioğlu MM, Yaradilmiş RM, Aydın O, Yasar D, Güngör A, Bodur IL, Göktuğ A, Sayici ILU, Örün UA, Karacan CD, Tuygun N. An analysis of cardiology consultation requests in infants presented to the pediatric emergency department of a tertiary children's hospital. Postgrad Med 2023; 135:676-680. [PMID: 37731167 DOI: 10.1080/00325481.2023.2261356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Cardiological emergencies are reported to constitute almost 15% of all emergency department visits. This study aimed to characterize the main signs and symptoms of the infants that necessitated pediatric cardiology consultation and to analyze the characteristics of patients diagnosed with a cardiological disorder. MATERIAL AND METHODS Patients aged 1 month to 1 year who were consulted to the pediatric cardiology service during a 4-year period were retrospectively evaluated. Patients' age, sex, nationality, complaints at PED, physical examination findings, reason for echocardiography (echo) and final diagnosis were recorded from the hospital medical record system for further analysis. Patients were divided into two groups according to the severity of the echo findings (patients with significant cardiovascular issues and patients without significant cardiovascular issues). RESULTS Of the 200 patients included in the study, 19 were in the significant cardiovascular issues, and 181 were in the without significant cardiovascular issue group. The leading complaints of the patients who were consulted to cardiology were cyanosis (22.5%), seizure (22.5%), cough (22%), and fever (19.5%). In emergency presentations, jaundice (16%), nutritional problems (21%), and cardiomegaly (21%) on x-rays were higher in patients with significant cardiovascular issues (p < 0.05). CONCLUSION In conclusion, congenital heart disease is usually diagnosed in the neonatal period, but some patients may be missed due to a variety of symptoms and findings. Infants with feeding problems and jaundice, especially those with cardiomegaly on chest radiographs, should be carefully evaluated for underlying serious congenital heart disease.
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Affiliation(s)
- Betül Öztürk
- Department of Pediatric Emergency, Ankara Etlik City Hospital, Ankara, Turkey
| | | | | | - Orkun Aydın
- Department of Pediatric Emergency, Ankara Etlik City Hospital, Ankara, Turkey
| | - Deniz Yasar
- Department General Pediatric, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ali Güngör
- Department of Pediatric Emergency, Ankara Etlik City Hospital, Ankara, Turkey
| | - I Lknur Bodur
- Dr. Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency, Istanbul Medeniyet Universitesi Goztepe Egitim Arastirma Hastanesi, Istanbul, Türkiye
| | - I Lker Ufuk Sayici
- Department of Pediatric Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Care, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency, Ankara Etlik City Hospital, Ankara, Turkey
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Assadi A, Laussen PC, Freire G, Trbovich P. Understanding Clinician Macrocognition to Inform the Design of a Congenital Heart Disease Clinical Decision Support System. Front Cardiovasc Med 2022; 9:767378. [PMID: 35187118 PMCID: PMC8850471 DOI: 10.3389/fcvm.2022.767378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute treatment requires guidance of CHD experts. Many children with CHD, however, present to their local emergency departments (ED) with gastrointestinal and respiratory symptoms that closely mimic symptoms of CHD related heart failure. This can lead to incorrect or delayed diagnosis and treatment where CHD expertise is limited. An understanding of the differences in cognitive decision-making processes between CHD experts and ED physicians can inform how best to support ED physicians when treating CHD patients. Methods Cardiac intensivists (CHD experts) and pediatric emergency department physicians (ED physicians) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Schubert and Klein's macrocognitive frameworks and inductively to allow for new or modified characterization of dimensions. Results In total, 6 CHD experts and 7 ED physicians were interviewed for this study. Although both CHD experts and ED physicians spent a lot of time sensemaking, their approaches to sensemaking differed. CHD experts reported readily recognizing the physiology of complex congenital heart disease and focused primarily on ruling out cardiac causes for the presenting illness. ED physicians reported a delay in attributing the signs and symptoms of the presenting illness to congenital heart disease, because these clinical findings were often non-specific, and thus explored different diagnoses. CHD experts moved quickly to treatment and more time anticipating potential problems and making specific contingency plans, while ED physicians spent more time gathering a range of data prior to arriving at a diagnosis. These findings were then applied to develop a prototype web-based decision support application for patients with CHD. Conclusion There are differences in the cognitive processes used by CHD experts and ED physicians when managing CHD patients. An understanding of differences in the cognitive processes used by CHD experts and ED physicians can inform the development of potential interventions, such as clinical decision support systems and training pathways, to support decision making pertaining to the acute treatment of pediatric CHD patients.
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Affiliation(s)
- Azadeh Assadi
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
- Department of Engineering and Applied Sciences, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- *Correspondence: Azadeh Assadi
| | - Peter C. Laussen
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Executive Vice President for Health Affairs, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Gabrielle Freire
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Patricia Trbovich
- Department of Engineering and Applied Sciences, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
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Mannenbach MS, Passe RL, Lovik KK, Larson EM, Laudon SM, Naeve A, Bellolio MF. Caring for Children With Autism in an Emergency Department Setting. Pediatr Emerg Care 2021; 37:e977-e980. [PMID: 33170575 DOI: 10.1097/pec.0000000000001844] [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: 11/26/2022]
Abstract
OBJECTIVE Patients with autism spectrum disorder (ASD) and other developmental delays represent a unique patient population. We described a cohort of children with ASD cared for in an emergency department (ED) setting and the specific health care resources used for their care. METHODS This is an observational study of consecutive children (<18 years) with ASD presenting for ED care. Comparisons of interest were evaluated using Wilcoxon rank sum and χ2 tests. Odds ratios (ORs) are reported with 95% confidence intervals (CIs). RESULTS There were 238 ED visits over a 9-month period among 175 children. Median age was 9 years, and 62% were male. Reasons for ED visit were medical (51%), psychiatric (18%), injury/assault/trauma (16%), neurological (11%), and procedure related (4%.)Children with psychiatric complaints had longer lengths of stay than those with other chief complaints (P < 0.0001; OR, 5.8; CI, 2.8-11.9) and were more likely to have urine (OR, 8.5; CI, 3.9-18.3) and blood work ordered (OR, 2.5; CI, 1.2-4.9) and less likely to have x-rays ordered (OR, 0.10; CI, 0.02-0.44).Eighteen (8%) children received sedation. None required physical restraint. A total of 30% were admitted to the hospital. Those with psychiatric complaints were more likely to be admitted (54.8% vs 24.5%; OR, 3.7; CI, 1.9-7.4) than those with other chief complaints. CONCLUSIONS The care for children with ASD varied with age and health care issues. There was a high prevalence of psychiatric complaints, and many of these children were boarded in the ED waiting for an inpatient psychiatric bed. Those with psychiatric complaints were more likely to have multiple tests ordered and were more likely to be admitted.
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Strobel AM, Alblaihed L. Cardiac Emergencies in Kids. Emerg Med Clin North Am 2021; 39:605-625. [PMID: 34215405 DOI: 10.1016/j.emc.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Encountering a child with congenital heart disease after surgical palliation in the emergency department, specifically the single-ventricle or ventricular assist device, without a basic familiarity of these surgeries can be extremely anxiety provoking. Knowing what common conditions or complications may cause these children to visit the emergency department and how to stabilize will improve the chance for survival and is the premise for this article, regardless of practice setting.
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Affiliation(s)
- Ashley M Strobel
- Department of Emergency Medicine, University of Minnesota Medical School, Hennepin County Medical Center, University of Minnesota Masonic Children's Hospital, 701 South Park Avenue R2.123, Minneapolis, MN 55414, USA.
| | - Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, University of Maryland Upper Chesapeake Medical System, 500 Upper Chesapeake Drive, Bel Air, MD 21014, USA
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Characteristics of Patients With Congenital Heart Disease Requiring ICU Admission From Japanese Emergency Departments. Pediatr Crit Care Med 2020; 21:e1106-e1112. [PMID: 32769701 DOI: 10.1097/pcc.0000000000002440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the characteristics of patients with congenital heart disease requiring ICU admission from emergency departments and determine the associations between the reasons for emergency department visits and specific congenital heart disease types or cardiac procedures. DESIGN Retrospective observational study using data from a Japanese multicenter database. SETTING Twelve PICUs and 11 general ICUs in Japan. PATIENTS All patients requiring ICU admission from an emergency department during 2013-2018, divided into two groups: with congenital heart disease and without congenital heart disease groups. INTERVENTIONS None for this analysis. MEASUREMENTS AND MAIN RESULTS Of the 297 patients with congenital heart disease (9.2% of a total of 3,240 patients), more than half had moderate-to-high complexity congenital heart disease; most of them were pediatric patients who had visited specialized congenital heart disease centers. All the patients' clinical outcomes were similar. Regarding the reasons for emergency department admission, seizure was significantly associated with a single ventricle anatomy (odds ratio, 3.3; 95% CI, 1.1-10.0), post-Glenn shunt placement (odds ratio, 5.6; 95% CI, 1.1-29.4), and a Fontan-type operation status (odds ratio, 6.3; 95% CI, 1.5-25.5). Sepsis and gastrointestinal bleeding were associated with asplenia (odds ratio, 21.1; 95% CI, 4.3-104 and odds ratio, 21.0; 95% CI, 3.1-141, respectively); gastrointestinal bleeding was also associated with systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125) and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). Arrhythmia was associated with a single ventricle anatomy (odds ratio, 21.0; 95% CI, 3.1-141), systemic-to-pulmonary artery shunt placement (odds ratio, 18.8; 95% CI, 2.8-125), and a Fontan-type operation status (odds ratio, 17.0; 95% CI, 2.6-112). CONCLUSIONS Classification of the reasons for emergency department admission by congenital heart disease type and surgical stage may guide clinicians in the selection of appropriate treatments in such settings.
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Abstract
BACKGROUND We aimed to conduct a multi-centre study characterising emergency department utilisation and critical readmissions experienced by children with Fontan circulation. METHODS We conducted a retrospective review of children who underwent the Fontan operation at three institutions (i.e., centres A, B, and C) between 2009 and 2014, with follow-up through December 2015. Multi-variable analyses were performed to determine factors associated for emergency department utilisation within 1 year of surgery, emergency department utilisation at any time following surgery, or critical readmission (defined as admission to ICU, operating room, or cardiac catheterisation). RESULTS We reviewed 297 patients, of which 147 patients (49%) had 607 emergency department encounters. Forty-six patients (15%) required 71 critical readmissions. Multi-variable analyses revealed centre C (p = 0.02) and post-operative hospitalisation ≥ 14 days (p = 0.03) to be significantly associated with emergency department utilisation within 1 year, whereas centre B (p < 0.001), post-operative hospitalisation ≥ 14 days (p = 0.002), and African-American/Black race (p = 0.04) were significantly associated with critical readmission. CONCLUSIONS In this multi-centre study, nearly half of patients with Fontan circulation received emergency department care, often presenting with high disease acuity requiring readmission. Emergency department utilisation and need for critical readmission were independently influenced by the centre at which surgery was performed, prolonged post-operative hospitalisation, and racial background. These data could help guide quality improvement efforts aimed at reducing morbidity in this unique patient population.
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There Is a Child With Congenital Heart Disease in My Emergency Department and They Need an ICU Bed…. Pediatr Crit Care Med 2020; 21:1096-1097. [PMID: 33278220 DOI: 10.1097/pcc.0000000000002490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bano S, Akhtar S, Khan U. Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital. Pak J Med Sci 2020; 36:333-337. [PMID: 32292429 PMCID: PMC7150392 DOI: 10.12669/pjms.36.3.1592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan. Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as a separate encounter. Results: Out of 133 children, 44 (33.5%) were diagnosed congenital cardiac disease for the first time (Group-1) in ED, while 89 (66.5%) children were diagnosed cases of congenital heart disease (Group-2). Among Group-1; main reasons for ED visits were cyanosis, cardiac failure, murmur evaluation and cardiogenic shock where as in Group-2; main presentations were cardiac failure, hyper cyanotic spells, gastroenteritis, lower respiratory tract infection, and post-operative issues. There were total 13 deaths. Conclusion: High index of suspicion is necessary for early diagnosis and management of children with congenital heart disease in the pediatric emergency department.
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Affiliation(s)
- Surraiya Bano
- Dr. Surraiya Bano, MBBS, MCPS, FCPS (Peds). Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saleem Akhtar
- Dr. Saleem Akhtar, MBBS, MCPS, FCPS (Peds), FCPS (Peds Cardiology) Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Uzma Khan
- Dr. Uzma Khan, MBBS. Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Assadi A, Laussen P, Trbovich P. Mixed-methods approach to understanding clinician macrocognition in the design of a clinical decision support tool: a study protocol. BMJ Open 2020; 10:e035313. [PMID: 32213525 PMCID: PMC7170622 DOI: 10.1136/bmjopen-2019-035313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The anatomic variants of congenital heart disease (CHD) are multiple. The increased survival of these patients and disposition into communities has led to an increase in their acute presentation to non-CHD experts in primary care clinics and emergency departments. Given the vulnerability and fragility of these patients in the face of acute illness, new clinical decision support systems (CDSS) are urgently needed to better translate the best practice recommendations for the care of these patients. This study aims to understand the perceived confidence and macrocognitive processes of non-CHD experts (emergency medicine physicians) and CHD experts (paediatric cardiac intensivists) when treating children with CHD during acute illness and apply this to optimise the design of a CDSS (MyHeartPass™) for these patients. METHODS AND ANALYSIS The first phase of the study involves a survey of non-CHD experts and CHD experts to understand their perceived confidence as it relates to treating acutely ill patients with CHD. The second phase is a qualitative cognitive task analysis using critical decision method to characterise and compare the macrocognitive processes used by non-CHD experts and CHD experts during the critical decision making. In phases 3 and 4, heuristic evaluation and usability testing of the CDSS will be completed. These results will be used to inform design changes to the chosen CDSS (MyHeartPass™). In the final phase, a within-participant simulation design will be used to study the effect of the CDSS on clinical decision making compared with baseline (without use of CDSS). ETHICS AND DISSEMINATION Ethics approval from The Hospital for Sick Children in Toronto, Ontario, Canada has been obtained for all phases. Results will be published in peer-reviewed journals and presented at relevant conferences. On successful completion of these studies, it is anticipated that there will be a controlled implementation of the redesigned CDSS.
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Affiliation(s)
- Azadeh Assadi
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto Faculty of Applied Science and Engineering, Toronto, Ontario, Canada
| | - Peter Laussen
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Human Era, Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Fisher JD, Bechtel RJ, Siddiqui KN, Nelson DG, Nezam A. Clinical spectrum of previously undiagnosed pediatric cardiac disease. Am J Emerg Med 2019; 37:933-936. [PMID: 30833044 DOI: 10.1016/j.ajem.2019.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022] Open
Abstract
Previously undiagnosed pediatric cardiac disease represents a clinical challenge for the emergency physician. The clinical presentation of these disorders can mimic other conditions of the respiratory, gastrointestinal and neurologic systems at a time when the need for early identification and treatment is at a premium. A high index of suspicion and superb clinical acumen is required to make a timely diagnosis and initiate optimal care. METHODS A retrospective chart review using explicit criteria and a structured data collection process was performed on all children presenting with previously undiagnosed cardiac disease over a five and half year period. RESULTS Thirty-six patients were identified over a five and a half year period representing one patient per 4838 pediatric ED presentations. A diverse set of chief complaints, triage categories, clinical presentations and diagnoses were identified. Undiagnosed congenital lesions, acquired cardiac disease, dysrhythmias and infectious diseases of the heart were represented. The need for surgical intervention (22%) and mortality (6%) was substantial. CONCLUSION In the aggregate, these conditions occur at an important rate and represent a high risk subset of pediatric patients presenting to the emergency department. Individually, the conditions occur infrequently and 'pattern recognition' may not aid the clinician. Early diagnosis and prompt intervention is important in this population.
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Affiliation(s)
- Jay D Fisher
- UNLV School of Medicine, Department of Emergency Medicine, United States of America.
| | - Robert J Bechtel
- UNLV School of Medicine, Department of Emergency Medicine, United States of America
| | - Korrina N Siddiqui
- UNLV School of Medicine, Department of Emergency Medicine, United States of America
| | - David G Nelson
- UNLV School of Medicine, Department of Emergency Medicine, United States of America
| | - Ahmad Nezam
- UNLV School of Medicine, Department of Emergency Medicine, United States of America
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
This article presents an approach for identification of infants with congenital heart disorders. These disorders are difficult to diagnose because of the complexity and variety of cardiac malformations; additionally presentation can be complicated by age-dependent physiology. By compiling data from the history and the physical examination, the emergency physician can identify lesion category and initiate stabilization procedures. Critical congenital cardiac lesions can be classified as left-sided obstructive ductal dependent, right-sided obstructive ductal dependent, and shunting or mixing. The simplified approach categorizes infants with these lesions respectively as "pink," "blue," or "gray." The emergency provider can provide life-saving stabilization until specialized care can be obtained.
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Emergency Department Management of Pediatric Patients with Cyanotic Heart Disease and Fever. J Emerg Med 2013; 44:599-604. [DOI: 10.1016/j.jemermed.2012.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 09/03/2012] [Accepted: 09/18/2012] [Indexed: 11/23/2022]
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Lee YS, Baek JS, Kwon BS, Kim GB, Bae EJ, Noh CI, Choi JY, Yun YS. Pediatric emergency room presentation of congenital heart disease. Korean Circ J 2010; 40:36-41. [PMID: 20111651 PMCID: PMC2812796 DOI: 10.4070/kcj.2010.40.1.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/23/2009] [Accepted: 07/29/2009] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Only a few studies have specifically investigated the reasons for emergency room (ER) visits in patients with congenital heart disease (CHD). The aim of this study was to identify the major reasons for ER presentation among patients with CHD that were acutely and seriously ill at a tertiary medical center in Korea. Subjects and Methods All 368 admissions of patients with CHD via the ER from 2003 to 2008 were enrolled. We conducted a retrospective study with review of the medical records. Results Eighty two patients were newly diagnosed as having CHD. Their major presentations were: symptoms of heart failure (41.5%), murmur (31.7%), and cyanosis (18.3%). There were 286 visits that were cases with known CHD. Their major presentations were respiratory tract infection (24.1%, 2.7±4.1 years of age), dysrhythmia (16.4%, 16.7±9.5 years), symptoms of heart failure (14.3%, 7.6±9.4 years), aggravated cyanosis (5.6%, 0.8±1.4 years), protein-losing enteropathy (4.9%), hemoptysis (4.5%), drug side effects (4.1%), and infective endocarditis (3.0%). There were significant correlations between the age distributions and major modes of presentation. Surgical treatments were required within 1 month in 38%, and 2.7% of all patients died during hospitalization. The patient group with respiratory infections and CHD showed the highest mortality (5.8%). Atrial flutter was the most frequent arrhythmia (70.2%) and 70% of these patients were post-Fontan surgery condition. The causes of heart failure in the patients with previous surgical repair were: pulmonary hypertension, myocardial dysfunction, valve regurgitation, and uncorrected lesions. Conclusion Improved understanding of the common problems in the ER can help prepare clinicians to manage patients that present with CHD.
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Affiliation(s)
- Yun Sik Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Chan TC, Sharieff GQ, Brady WJ. Electrocardiographic manifestations: pediatric ECG. J Emerg Med 2008; 35:421-30. [PMID: 18439791 DOI: 10.1016/j.jemermed.2007.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 09/05/2007] [Accepted: 09/06/2007] [Indexed: 11/27/2022]
Abstract
Interpretation of pediatric electrocardiograms (ECGs) can be challenging for the Emergency Physician. Part of this difficulty arises from the fact that the normal ECG findings, including rate, rhythm, axis, intervals and morphology, change from the neonatal period through infancy, childhood, and adolescence. These changes occur as a result of the maturation of the myocardium and cardiovascular system with age. Along with these changes, up to 20% of pediatric ECGs obtained in the acute setting may have clinically significant abnormal findings. This article will discuss the approach to the interpretation of ECGs in children, the age-related findings and alterations on the normal pediatric ECG, and those ECG abnormalities associated with pediatric cardiac diseases, including the variety of congenital heart diseases seen in children.
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Affiliation(s)
- Theodore C Chan
- Department of Emergency Medicine, University of California San Diego Medical Center, and San Diego Children's Hospital, San Diego, California 92103, USA
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Abstract
OBJECTIVE To define the modes of presentation, incidence of major organ dysfunction, predictors of hospital mortality, and adverse outcomes in neonates with critical heart disease admitted to a tertiary care center. DESIGN Retrospective chart review. SETTING A tertiary care pediatric cardiac intensive care unit and neonatal intensive care unit. PATIENTS The medical records for all neonates (< or = 30 days of age) with heart disease admitted to the cardiac intensive care unit or neonatal intensive care unit between October 1, 2002, and September 30, 2003, were reviewed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 190 neonates met inclusion criteria during this 1-yr period, of which 146 (77%) had at least one surgical procedure. Single ventricle heart disease was present in 42%. The most common mode of presentation was following a prenatal diagnosis (53%), followed by diagnosis in the newborn nursery (38%) and diagnosis after newborn hospital discharge (8%). The most common presenting findings in the newborn nursery were isolated murmur (38%) or cyanosis (32%), while circulatory collapse (38%) was the most common presentation after discharge. For the entire study cohort, 13% had a known genetic syndrome, 23% had a major noncardiac congenital anomaly, and 16% weighed < 2.5 kg. The hospital mortality for the entire cohort was 7.4%. Risk factors associated with an increased risk of hospital mortality included younger age at admission, higher number of cardiopulmonary bypass runs, and need for postoperative cardiopulmonary resuscitation. Total hospital length of stay was > 1 month in 17% of neonates. CONCLUSIONS In patients with complex congenital heart disease, including nearly half with single ventricle heart disease, neonatal hospital mortality was 7%. These patients have a high frequency of multiple congenital anomalies, genetic syndromes, low birth weight, and prolonged length of stay.
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Abstract
Knowledge of the basics of pediatric ECG interpretation is helpful in differentiating normal from abnormal findings. These basics include familiarity with the age-related normal findings in heart rate, intervals, axis, and waveform morphologies; an understand-ing of cardiac physiologic changes associated with age and maturation, particularly the adaptation from right to left ventricular predominance; and a rudimentary understanding of common pediatric dysrhythmias and findings associated with congenital heart diseases.
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Affiliation(s)
- Ghazala Q Sharieff
- Children's Hospital and Health Center/University of California-San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
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Brown K. The Infant With Undiagnosed Cardiac Disease in the Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2005. [DOI: 10.1016/j.cpem.2005.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Piastra M, Polidori G, De Carolis MP, Tempera A, Caresta E, Pulitanò S, Chiaretti A, Valentini P, De Rosa G. Fatal coronary artery anomaly presenting as bronchiolitis. Eur J Pediatr 2005; 164:515-9. [PMID: 15889276 DOI: 10.1007/s00431-005-1684-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respiratory tract infection and wheezing. The clinical condition in two cases was rapidly progressive and precipitated into intractable shock; clinical and instrumental examinations revealed a cardiac origin of their illness. A subacute presentation permitted a cardiological assessment and a proper treatment in the third infant. An abnormal origin of the left coronary artery from the pulmonary trunk was demonstrated in all cases. The concurrent acute airway infection had a catastrophic effect on the underlying cardiovascular anomaly leading to refractory cardiogenic shock and death. CONCLUSION Admission chest X-ray film and arterial gas analysis can raise the suspicion of cardiac involvement when treating a severe wheezing episode in young infants. Paediatric cardiological evaluation with two-dimensional echocardiography may eventually reveal this rare condition, whereas cardiac catheterisation with aortography remains the standard means of diagnosis.
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Affiliation(s)
- Marco Piastra
- Paediatric Intensive Care Unit, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
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Abstract
Although pediatric cardiac disorders are not commonly seen in the Emergency Department, they are important to identify to prevent further morbidity or mortality. Diagnosis may be complicated by the lack of classic complaints such as chest pain or palpitations that are commonly associated with cardiac disorders. In fact, presenting complaints associated with pediatric cardiac disorders, like "fussiness" or "difficulty feeding," may seem quite nonspecific. This article reviews pertinent issues concerning diagnosis and management of pediatric cardiac disorders including supraventricular tachycardia, congenital heart disease, prolonged QT syndrome, pericarditis, myocarditis, rheumatic fever, and endocarditis. It also reviews abnormal findings in pediatric electrocardiograms.
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Affiliation(s)
- Ghazala Q Sharieff
- Department of Emergency Medicine, University Of Florida, Shands, Jacksonville, Florida 32209, USA
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