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Kim JS, Seo DW, Kim YJ, Hong SI, Kang H, Kim SJ, Han KS, Lee SW, Moon S, Kim WY. Emergency Department as the Entry Point to Inpatient Care: A Nationwide, Population-Based Study in South Korea, 2016-2018. J Clin Med 2021; 10:jcm10081747. [PMID: 33920592 PMCID: PMC8072932 DOI: 10.3390/jcm10081747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: The emergency department provides lifesaving treatment and has become an entry point to hospital admission. The purpose of our study was to describe the characteristics and outcomes of patients who were admitted through the emergency department to the intensive care unit or general ward. (2) Methods: We performed a retrospective, cross-sectional, descriptive analysis using the National Emergency Department Information System, analyzing patient data including disease category, diagnosis, and mortality from 1 January 2016, to 31 December 2018. (3) Results: During the study period, about 13.6% were admitted through the emergency department. Of these, the overall in-hospital mortality was 4.6%. The frequent disease class for the intensive care unit admissions was the cardiovascular system, and the classes for the general ward admissions were as follows: injury and toxicology, digestive system, and respiratory system. Cardiovascular system-related emergencies were the predominant cause of death among patients admitted to the intensive care unit; however, oncologic complications were the leading cause of death in the general ward. (4) Conclusions: Emergency departments are incrementally utilized as the entry point for hospital admission. Health care providers need to understand emergency department admission epidemiology and prepare for managing patients with certain common diagnoses.
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Affiliation(s)
- June-sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Seok In Hong
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Kap Su Han
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
- Correspondence: ; Tel.: +82-2-3010-3350
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Simma L, Stocker M, Lehner M, Wehrli L, Righini-Grunder F. Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study. Front Pediatr 2021; 9:721646. [PMID: 34708009 PMCID: PMC8544259 DOI: 10.3389/fped.2021.721646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission. Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018-2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital. Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%). Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Lucerne, Switzerland.,Emergency Department, University's Children Hospital Zurich, Zurich, Switzerland
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Lea Wehrli
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
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Brugnolaro V, Fovino LN, Calgaro S, Putoto G, Muhelo AR, Gregori D, Azzolina D, Bressan S, Da Dalt L. Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique. PLoS One 2020; 15:e0241209. [PMID: 33147242 PMCID: PMC7641453 DOI: 10.1371/journal.pone.0241209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background An effective pediatric emergency care (PEC) system is key to reduce pediatric mortality in low-income countries. While data on pediatric emergencies from these countries can drive the development and adjustment of such a system, they are very scant, especially from Africa. We aimed to describe the characteristics and outcomes of presentations to a tertiary-care Pediatric Emergency Department (PED) in Mozambique. Methods We retrospectively reviewed PED presentations to the "Hospital Central da Beira" between April 2017 and March 2018. Multivariable logistic regression was used to identify predictors of hospitalization and death. Results We retrieved 24,844 presentations. The median age was 3 years (IQR 1-7 years), and 92% lived in the urban area. Complaints were injury-related in 33% of cases and medical in 67%. Data on presenting complaints (retrieved from hospital paper-based registries) were available for 14,204 (57.2%) records. Of these, respiratory diseases (29.3%), fever (26.7%), and gastrointestinal disorders (14.2%) were the most common. Overall, 4,997 (20.1%) encounters resulted in hospitalization. Mortality in the PED was 1.6% (62% ≤4 hours from arrival) and was the highest in neonates (16%; 89% ≤4 hours from arrival). A younger age, especially younger than 28 days, living in the extra-urban area and being referred to the PED by a health care provider were all significantly associated with both hospitalization and death in the PED at the multivariable analysis. Conclusions Injuries were a common presentation to a referral PED in Mozambique. Hospitalization rate and mortality in the PED were high, with neonates being the most vulnerable. Optimization of data registration will be key to obtain more accurate data to learn from and guide the development of PEC in Mozambique. Our data can help build an effective PEC system tailored to the local needs.
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Affiliation(s)
- Valentina Brugnolaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- * E-mail:
| | - Laura Nai Fovino
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Serena Calgaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | | | - Dario Gregori
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
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Chen SX, Fan K, Leung LP. Epidemiological characteristics and disease spectrum of emergency patients in two cities in China: Hong Kong and Shenzhen. World J Emerg Med 2020; 11:48-53. [PMID: 31893003 DOI: 10.5847/wjem.j.1920-8642.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shao-Xi Chen
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Karren Fan
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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Disease Spectrum and Frequency of Illness in Pediatric Emergency: A Retrospective Analysis From Karachi, Pakistan. Ochsner J 2019; 19:340-346. [PMID: 31903057 PMCID: PMC6928663 DOI: 10.31486/toj.18.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The National Institute of Child Health (NICH) is the largest tertiary care pediatric hospital operating in Karachi, Pakistan. Its emergency department (ED) is always occupied. However, the spectrum of illness in patients presenting to this ED has not been investigated in depth to identify the most common presentations and to develop effective management for treating patients. Methods: This retrospective study included all children visiting the pediatric ED of the NICH from January 2017 through December 2017. Newborns to children 14 years of age were included, for a total cohort of 188,803 patients. Sociodemographic data and clinical information were extracted from the medical record. Univariate analysis was performed to determine the frequency and percentage for all the variables. Results: The cohort consisted of 9% (n=16,952) neonates (0 to 1 month) and 91% (n=171,351) older children (>1 month to 14 years). Among the neonates, 36.6% presented as triage level 1. Sepsis was diagnosed in 23.8% of neonates, low birth weight/preterm in 18.4%, and respiratory distress/pneumonia in 15.2%. In infants and older children, diagnoses related to the respiratory system (37.3%), gastrointestinal system (16.4%), and multisystem involvement (15.9%) were the most common. During the evening shifts, 38.1% of patients were seen, and on weekends, 51.6% of patients were seen. Sunday was the busiest day in the ED. Conclusion: The tertiary care pediatric EDs in Pakistan have witnessed an increasing number of critical emergencies over time. Respiratory and gastrointestinal emergencies form the majority of the ED burden. A surge of patients is seen on the weekends and during the evening shifts. The spectrum of illnesses should be investigated via prospective, longitudinal studies in other pediatric EDs in Pakistan to understand the trends and to provide the foundation for developing nationwide recommendations for improving pediatric emergency care.
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Campbell M. Sex differences in mortality among critically ill children in Pakistan. Arch Emerg Med 2018; 35:460. [DOI: 10.1136/emermed-2018-207512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/03/2022]
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