The characteristics of pediatric emergency department visits in Korea: An observational study analyzing Korea Health Panel data

Examination of the transport characteristics of pediatric trauma patients

Background/aim

Injury is an important public health problem in the pediatric age group and one of the leading global causes of morbidity and mortality. The fact that pediatric trauma has a significant impact on patients, families, and countries shows the need for a better understanding of this phenomenon. This study investigates the demographic characteristics, reasons for admission to the hospital, and diagnoses of pediatric trauma patients who received prehospital emergency health services.

Materials and methods

This study was designed as a retrospective observational study and included all patients under the age of 18 who received emergency healthcare due to trauma and were registered in the Emergency Health Automation System after a call was placed to the emergency call center between 1 January 2018 and 31 December 2022. Information such as the reason for calling an ambulance, ICD-10 diagnosis codes, mechanism of injury, time of arrival at the scene, transport duration from the scene to the hospital, and reasons for interfacility transfers were collected for all patients.

Results

A total of 37,420 patients were included in the analysis. Seventeen patients were found dead at the scene of the trauma and 35 patients experienced cardiac arrest on the way to the hospital from the scene. The difference between age groups in terms of time from arrival at the scene to arrival at the hospital was statistically significant (p < 0.001). Falls were the most common cause of trauma in all age groups, followed by traffic accidents. Patients requiring a specialist and transferred primarily for fall-related injuries were in direct proportion to the total number of cases (65.0%, n = 1838), followed by cases of traffic accidents and sports injuries. Most of the secondary transports were made to a training and research hospital or state hospital.

Conclusion

Targeted preventive measures and community education should address the specific causes of trauma that are more prevalent in certain age groups. Early identification of special patient groups that typically require secondary transport can reduce mortality and morbidity related to trauma by facilitating direct transfers to appropriate hospitals.

Profile of patients visiting the emergency departments at Haji Adam Malik and Universitas Sumatera Utara hospitals in Medan, Indonesia

Objectives

Data on the patient profiles and characteristics of emergency department (ED) visits are crucial for enhancing hospital emergency care resources and developing a more effective emergency healthcare unit. The aim of this study was to report the characteristics and trends of pediatric ED visits at Haji Adam Malik (HAM) and Universitas Sumatera Utara (USU) hospitals in Medan, Indonesia, during the year 2020.

Methods

This was a retrospective descriptive study conducted in HAM Hospital and USU Hospital, using patient medical records data extracted from the hospital information systems for the period January to December 2020.

Results

This study included 3462 pediatric patients as participants. The majority of the patients in this study were male (57.8%), and the most represented age group was 11-18 years (35.8%). Trauma/injury was the most common ED diagnosis at HAM Hospital, whereas unspecified fever was the most common reason for visits to the ED at USU Hospital. The majority of patients attending the ED at HAM Hospital were hospitalized, while the majority at USU Hospital were treated as outpatients.

Conclusions

This study found that the most frequent diagnosis in the ED was trauma/injury at HAM Hospital and unspecified fever at USU Hospital.

The Changing Trend of Paediatric Emergency Department Visits in Malaysia Following the COVID-19 Pandemic

Background The coronavirus disease 2019 (COVID-19) pandemic has impacted the emergency department (ED) due to the surge in medical demand and changes in the characteristics of paediatric visits. Additionally, the trend for paediatric ED visits has decreased globally, secondary to implementing lockdowns to stop the spread of COVID-19. We aim to study the trend and characteristics of paediatric ED visits following Malaysia's primary timeline of the COVID-19 pandemic. Methods and materials A five-year time series observational study of paediatric ED patients from two tertiary hospitals in Malaysia was conducted from March 17, 2017 (week 11 2017) to March 17, 2022 (week 12 2022). Aggregated weekly data were analysed using R statistical software version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria) against significant events during the COVID-19 pandemic to detect influential changepoints in the trend. The data collected were the number of ED visits, triage severity, visit outcomes and ED discharge diagnosis. Results Overall, 175,737 paediatric ED visits were recorded with a median age of three years and predominantly males (56.8%). A 57.57% (p<0.00) reduction in the average weekly ED visits was observed during the Movement Control Order (MCO) period. Despite the increase in the proportion of urgent (odds ratio (OR): 1.23, p<0.00) and emergent or life-threatening (OR: 1.79, p<0.00) cases, the proportion of admissions decreased. Whilst the changepoints during the MCO indicated a rise in respiratory, fever or other infectious diseases, or gastrointestinal conditions, diagnosis of complications originating from the perinatal period declined from July 19, 2021 (week 29 2021). Conclusion The incongruent change in disease severity and hospital admission reflects the potential effects of the healthcare system reform and socioeconomic impact as the pandemic evolves. Future studies on parental motivation to seek emergency medical attention may provide insight into the timing and choice of healthcare service utilisation.

Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database

We aim to investigate common diagnoses and risk factors for emergency department (ED) visits as well as those for hospitalization and death after ED visits. This study describes the clinical course of ED visits by using the 2014–2015 population data retrieved from the National Health Insurance Service. Sociodemographic, medical, and behavioral factors were analyzed through multiple logistic regression. Older people were more likely to be hospitalized or to die after an ED visit, but younger people showed a higher risk for ED visits. Females were at a higher risk for ED visits, but males were at a higher risk for ED-associated hospitalization and death. Individuals in the highest quartile of income had a lower risk of ED death relative to lowest income level individuals. Disabilities, comorbidities, and medical issues, including previous ED visits or prior hospitalizations, were risk factors for all ED-related outcomes. Unhealthy behaviors, including current smoking, heavy alcohol consumption, and not engaging in regular exercise, were also significantly associated with ED visits, hospitalization, and death. Common diagnoses and risk factors for ED visits and post-visit hospitalization and death found in this study provide a perspective from which to establish health polices for the emergency medical care system.

Virtual reality environment using a dome screen for procedural pain in young children during intravenous placement: A pilot randomized controlled trial

We assessed the feasibility and potential efficacy of a virtual reality (VR) environment using a dome screen as a distraction method in young children during intravenous (IV) placement in the pediatric emergency department. This randomized controlled pilot study enrolled children aged 2 to 6 years who underwent IV placement into either the intervention group or the control group. Children in the intervention group experienced VR using a dome screen during IV placement. The child’s pain intensity was measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at four time points of IV placement: immediately after arrival to the blood collection room (base); immediately after the child laid down on the bed (preparation); when the tourniquet was applied (tourniquet); and the moment at which the needle penetrated the skin (venipuncture). The guardian’s satisfaction and rating of the child’s distress were assessed using a 5-point Likert-type questionnaire. We recruited 19 children (9 in the intervention group and 10 in the control group). Five children in the control group were excluded from the analysis because of missing video recordings (n = 3), failed first attempt at IV placement (n = 1), and the child’s refusal to lie on the bed during the procedure (n = 1). No side effects of VR were reported during the study period. Although the average FLACC scale score at each time point (preparation, tourniquet, venipuncture) was lower in the intervention group than the control group, the difference was not statistically significant (2.3, interquartile range [IQR]: 2.0–3.0; vs. 3.3, IQR: 2.7–6.7, P = 0.255). There were no statistically significant differences between the groups in the guardian’s satisfaction and anxiety or his/her rating of the child’s pain and anxiety. The guardians and emergency medical technicians reported satisfaction with the use of VR with a dome screen and considered it a useful distraction during the procedure. VR using a dome screen is a feasible distraction method for young children during IV placement. A larger clinical trial with further development of the VR environment and study process is required to adequately evaluate the efficacy of VR using a dome screen.

The Tasmanian Conception to Community (C2C) Study Database 2008-09 to 2013-14: Using linked health administrative data to address each piece in the puzzle

BACKGROUND

Tasmania, Australia has a small widely dispersed regional and rural population. The Conception to Community (C2C) Study Database was established as a research platform to inform service planning and policy development and improve health outcomes for Tasmanian mothers and children. The aims of this study were to establish by maternal socio-demographic characteristics: 1) the distribution of births in Tasmania; 2) hospital utilisation for children from birth to 5-years; and 3) the association between child and maternal emergency department (ED) presentation rates.

METHODS

Perinatal and public hospital ED and admitted patient data were linked for every child born in Tasmania between 2008-09 to 2013-14, and their mothers. Individualised rates of ED presentations and hospital admissions were calculated from birth to 5-years. Frequent presenters to ED were defined as having at least four presentations per annum. Ratios of ED presentation and hospital admission rates by sociodemographic characteristics (region (north, north-west, south), rurality, maternal age, and area socioeconomic disadvantage) were estimated using mixed-effects negative binomial models, with random intercepts for each child and family.

RESULTS

The C2C Database is comprised of records for 37,041 children and 27,532 mothers. One-in-ten Tasmanian babies lived in a remote area. The mean yearly rate of ED presentations per child varied by sex, age, region and rurality. Frequent presenters were more likely to reside in the north-west or north, in urban areas, have mothers under 20- years, be male, and live in more disadvantaged areas, with 2.3% of children frequent presenters in their first year of life. The odds of a child being a frequent presenter during their first-year was 6.1- times higher if the mother was a frequent presenter during this period.

CONCLUSION

Associations between maternal and child health service use and combined effects of regionality and rurality highlight opportunities for targeted intervention and service innovations.

Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia

Background

The Emergency Room (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia.

Methods

This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome.

Results

The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38).

Conclusions

A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Maternal Smoking in Pregnancy and Child's Hospital Use up to 5 Years of Age in a Data Linkage Birth Cohort

OBJECTIVES

To examine if exposure to maternal smoking during pregnancy is associated with emergency department (ED) presentation and admission through the ED in children up to 5 years after birth.

METHODS

Antenatal records of all children up to 5 years of age who were born in Tasmania, Australia, between July 2008 and June 2014 were linked to health service use (ED presentations and hospital admissions). Negative binomial regression was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) at ≤1 year and ≤5 years for ED presentations and admissions to the hospital through the ED for any reason and by 9 major disease categories for children exposed versus children not exposed to maternal smoking during pregnancy. Models were adjusted for sex, socioeconomic position, maternal age at birth, and region of residence. Presentations and admissions for poisoning and injuries were used as a negative control.

RESULTS

Among 36 630 infants, 21% were exposed to maternal smoking during pregnancy. Exposed children had a 26% higher rate of presentation to the ED (IRR_adjusted 1.26; 95% CI 1.23-1.29) and a 45% higher rate of admission (IRR_adjusted 1.45; 95% CI 1.39-1.51) at up to 5 years of age. Compared with the negative control, higher presentation and admission rates were evident in respiratory; eyes, ears, nose, and throat; psychosocial; and infectious disease categories.

CONCLUSIONS

Higher health care service use was observed in children exposed to maternal smoking during pregnancy for a range of conditions associated with exposure to smoking. The findings reinforce the need to reduce smoking among people in their childbearing years.

Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?

The Korean National Health Insurance system imposes a 30% coinsurance for outpatient medical care and prescription drugs; however, at the age of 65, the coinsurance model changes to a copayment model that offers lower fees for the elderly. Thus, this study aimed to investigate the influence of the copayment model for outpatient visits and prescription drugs on healthcare utilization among the Korean elderly. We compared total outpatient visits, total prescriptions, and out-of-pocket expenses between a case group with copayment reduction (65 years or older) and a control group without any reduction (64 years or younger). We obtained secondary data collected from seven waves of the Korea Health Panel Survey (2010-2016). Outpatient visits increased exclusively in the case group among those with lower income. After adjusting for covariates, the results of the difference-in-differences analysis showed that, compared to the control group, there was a significant increase in outpatient visits among individuals with lower income in the case group. Our study shows that cost sharing changes affect Korean patients with different income levels in different ways.

Paediatric emergency department visits for non-urgent conditions: Can family medicine prevent this?

Background

In Turkey, family physicians serve only during office hours, while emergency services have 7/24 free access. Non-urgent patients commonly use Paediatric Emergency departments (PEDs). In Turkey, there is little evidence as to why emergency services are used instead of family medicine for non-urgent paediatric healthcare.

Objectives

To evaluate the causes and factors affecting non-urgent PED visits. To determine the reason for non-use of family medicine for non-urgent paediatric healthcare.

Methods

We conducted a cross-sectional study at Gaziantep University PED between April and May 2019. We administered a questionnaire to the parents of children (from one month to 16 years) triaged to non-urgent (level-5) using a 5-level triage system.

Results

A total of 457 parents were surveyed. The average patient age was 6.5 ± 4.7 years and 24.5% had a chronic disease. One-third of the parents (33.7%) considered their children’s condition ‘very urgent’. The most important reason for preferring PED (42.5%) instead of family physician or alternative health facilities was the thought that the condition of children would worsen. Two hundred fifty-three (55.4%) of the patients presented outside working hours. Although 58.9% of parents were satisfied with the family physician, most (67.8%) stated that they preferred other specialists rather than family physicians when the child had health problems. Fathers who were primary school graduates were more likely to prefer other specialists than family physicians.

Conclusion

Parents’ perception of urgency and the thought that their child’s condition will worsen are the main reasons for non-urgent using PED.

The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

Background and Objectives:

The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients’ clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients’ outcomes following transport were also investigated.

Methods:

This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought.

Results:

A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were delivered to pediatric emergency departments without notification calls. Although notification calls were more likely given for particularly critically ill children, for non-urgent conditions transfer calls were less common (60.8% vs 23.5%, respectively; p < 0.001). A majority of transports were performed for trauma patients (20.5%), neurological issues (20%), and toxicological emergencies (13.8%). While parents prefer using the ambulances for medical emergencies, physicians prefer it for mainly traumatic and toxicological emergencies. In total, 65% of the patients received at least one intervention, and 18 patients needed immediate life-saving interventions (intubation, cardiopulmonary resuscitation, etc.) but they did not receive it. Mortality occurred in nine patients. If the health care providers were paramedics, they were more likely avoided by performing any intervention in critically ill children ( p < 0.001). A majority of the procedures performed in children were older than 12 months ( p < 0.001).

Conclusion:

This study presents comprehensive epidemiological and outcome data for pediatric patients transported by the national emergency medical service system in Turkey. Non-urgent calls were more likely made by parents, physicians avoided making NCs, and paramedics also avoided performing any intervention when they were transporting children.

Clinical characteristics of enteroviral meningitis without pleocytosis in children: a retrospective single center observational study in the Republic of Korea

Background

We aimed to study the prevalence of enterovirus (EV) meningitis without the presence of cerebrospinal fluid (CSF) pleocytosis and identify patient factors and clinical features associated with it.

Methods

This was a retrospective analysis of patients aged < 18 years old who were diagnosed with EV meningitis by CSF reverse-transcriptase polymerase chain reaction (RT-PCR) testing between January 2015 and December 2016. Clinical variables were compared with regard to the presence of CSF pleocytosis.

Results

A total of 305 patients were enrolled in study; 169 (55.4%) had no pleocytosis. Patients without pleocytosis were younger (median age 2 months vs. 67.0 months, p < 0.01) and had lower white blood cell (WBC) count (median, 8600/mm³ vs. 10,300/mm³, p < 0.01). Also absolute neutrophil (ANC) count were lower than pleocytosis group (median, 4674/mm³ vs. 7600/mm³, p < 0.01). Comparing three age groups, CSF apleocytosis was present in 106 of 128 patients (82.8%) aged ≤3 months, 7 of 13 patients (53.8%) aged 3 months–3 years and 56 of 164 patients (34.1%) aged > 3 years. Younger age groups had higher prevalence of CSF apleocytosis (p < 0.01). In patients aged ≤3 months, 94.5% underwent lumbar puncture within 24 h of symptom onset. The frequency of not having pleocytosis was higher than the frequency of having pleocytosis during peak EV infection prevalent months (summer and fall) (p < 0.01).

Conclusion

This study shows that EV meningitis in young infants, with early lumbar puncture, or occurring during peak EV meningitis prevalent seasons cannot be solely excluded by pleocytosis. Also, a confirmation test for EV meningitis should be performed using RT-PCR.