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Tatlıparmak AC, Alpar S, Yilmaz S. Factors influencing recurrent emergency department visits for mild acute respiratory tract infections caused by the influenza virus. PeerJ 2023; 11:e16198. [PMID: 37818329 PMCID: PMC10561640 DOI: 10.7717/peerj.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Background Seasonal viral outbreaks, exemplified by influenza A and B viruses, lead to spikes in emergency department (ED) visits, straining healthcare facilities. Addressing ED overcrowding has become paramount due to its implications for patient care and healthcare operations. Recurrent visits among influenza patients remain an underexplored aspect, necessitating investigation into factors influencing such revisits. Methods Conducted within a tertiary care university hospital, this study adopts an observational retrospective cohort design. The study included adult patients with acute respiratory symptoms diagnosed with influenza using rapid antigen testing. The cohort was divided into single and recurrent ED visitors based on revisits within 10 days of initial discharge. A comparative analysis was performed, evaluating demographics, laboratory parameters, and clinical process data between recurrent visitors and single visitors. Results Among 218 patients, 36.2% (n = 139) experienced recurrent ED visits. Age and gender disparities were not significant. Antibiotics were prescribed for 55.5% (n = 121) and antivirals for 92.7% (n = 202) of patients, with no notable influence on recurrence. Recurrent visitors exhibited lower monocyte counts, hemoglobin levels, higher PDW and P-LCR percentages, and increased anemia prevalence (p = 0.036, p = 0.01, p = 0.004, p = 0.029, p = 0.017, respectively). C-reactive protein (CRP) levels did not significantly affect recurrence. Conclusion This study highlights the pressing concern of recurrent ED visits among mild influenza patients, magnifying the challenges of ED overcrowding. The observed notable prescription rates of antibiotics and antivirals underscore the intricate landscape of influenza management. Diminished monocyte counts, hemoglobin levels, and altered platelet parameters signify potential markers for identifying patients at risk of recurrent visits.
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Affiliation(s)
| | - Suleyman Alpar
- Department of Emergency Medicine, Beykent University, İstanbul, Turkey
| | - Sarper Yilmaz
- Deparment of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, Turkey
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Ghirardo S, Cozzi G, Tonin G, Risso FM, Dotta L, Zago A, Lupia D, Cogo P, Ullmann N, Coretti A, Badolato R, Amaddeo A, Barbi E, Cutrera R. Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician's attitude? Eur J Pediatr 2022; 181:3931-3936. [PMID: 36083314 PMCID: PMC9458479 DOI: 10.1007/s00431-022-04601-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (< 12 months) hospitalized for bronchiolitis in the last four winter seasons (1 September-31 March 2018-2022). In the 2021-2022 winter season, 66% of admitted children received HFNC versus 23%, 38%, and 35% in the previous 3 years. A total of 876 patients were hospitalized in the study periods. In 2021-2022, 300 infants were hospitalized for bronchiolitis, 22 in 2020-2021, 259 in 2019-2020, and 295 in 2018-2019. The percentage of patients needing intensive care varied from 28.7% to 18%, 22%, and 15% in each of the four considered periods (p < 0.05). Seventy-seven percent of children received oxygen in the 2021-2022 winter; vs 50%, 63%, and 55% (p < 0.01) in the previous 3 years. NIV/CPAP was used in 23%, 9%, 16%, and 12%, respectively. In 2021-2020, 2% of patients were intubated; 0 in 2020-2021, 3% in 2019-2020, and 1% in 2018-2019. CONCLUSION This study shows a marked increase in respiratory support and intensive care admissions this last winter. While these severity indexes were all driven by medical choices, more reliable indexes such as intubation rate and length of stay did not change. Therefore, we suggest that there is a more aggressive treatment attitude rather than a more severe disease. WHAT IS KNOWN • COVID-19 pandemic deeply impacted bronchiolitis epidemiology, reducing hospitalizations to onetenth. In the 2021-2022 winter, bronchiolitis resurged to pre-pandemic numbers in Europe. WHAT IS NEW • Bronchiolitis hospitalization rose much faster in the 2021-2022 winter period, peaking at a higher level. Respiratory supports and high-flow nasal cannula increased significantly compared to the pre-pandemic era.
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Affiliation(s)
- Sergio Ghirardo
- Unit of Pediatrics, Department of Medicine, University Hospital S. Maria della Misericordia, Viale San Daniele 27, Udine, Italy.
| | - Giorgio Cozzi
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giovanna Tonin
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, DAME, University of Udine, Udine, Italy
| | - Francesco Maria Risso
- grid.412725.7Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Dotta
- grid.7637.50000000417571846Department of Pediatrics, Università di Brescia, Istituto di Medicina Molecolare Angelo Nocivelli”, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Zago
- grid.5133.40000 0001 1941 4308University of Trieste, Trieste, Italy
| | - Daniela Lupia
- grid.414125.70000 0001 0727 6809Pediatric Pulmonology & Respiratory Intermediate Care Unit, Clinical, Management and Technology Innovation Research Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Paola Cogo
- grid.411492.bUnit of Pediatrics, Department of Medicine, University Hospital S. Maria della Misericordia, Viale San Daniele 27, Udine, Italy ,grid.5390.f0000 0001 2113 062XDepartment of Medicine, DAME, University of Udine, Udine, Italy
| | - Nicola Ullmann
- grid.414125.70000 0001 0727 6809Pediatric Pulmonology & Respiratory Intermediate Care Unit, Clinical, Management and Technology Innovation Research Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Antonella Coretti
- grid.414125.70000 0001 0727 6809Pediatric Pulmonology & Respiratory Intermediate Care Unit, Clinical, Management and Technology Innovation Research Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Raffaele Badolato
- grid.7637.50000000417571846Department of Pediatrics, Università di Brescia, Istituto di Medicina Molecolare Angelo Nocivelli”, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Amaddeo
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy ,grid.5133.40000 0001 1941 4308University of Trieste, Trieste, Italy
| | - Renato Cutrera
- grid.414125.70000 0001 0727 6809Pediatric Pulmonology & Respiratory Intermediate Care Unit, Clinical, Management and Technology Innovation Research Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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