Emergency department attendances associated with drug-related problems in paediatrics

OBJECTIVES: To determine the frequency and characteristics of paediatric emergency department attendances associated with drug-related problems (DRP) at three Victorian hospitals. METHODS: All paediatric medical patients attending the emergency department of the Royal Children's Hospital, Geelong Hospital or Box Hill Hospital were considered for inclusion. The investigator and attending medical practitioners screened eligible patients. A multidisciplinary panel reviewed collated data. Causality, preventability and clinical significance classifications were established by the panel. RESULTS: Combining data from the three hospitals, over 18 weeks of data collection, a total of 8601 patients met the eligibility criteria. Of these, 280 (3.3%, 95% CI 2.9-3.7%) were determined to have emergency department attendances associated with DRP. Of the 187 cases assessed for preventability, 51.3% were judged to be preventable. CONCLUSIONS: Emergency department attendances are associated with DRP in paediatrics. Given that the need to prevent DRP in adults is recognized, it is now time to act to reduce the consequences of DRP in paediatrics.     

The pediatric emergency department: assessment of clinical activity and interaction with local health authorities]

A perspective study was carried out at the Emergency Department of the Gaslini Institute on a sample of the children admitted from May to September 1990. The study aimed to describe types and modalities of admission. "G. Gaslini" Institute is a multidisciplinary children's hospital: 45% of patients admitted in the hospital come from the southern regions of Italy, while the admission at the Emergency Department were local in 82%. Among all children considered, 2080 (71.9% were admitted on request of their parents, who did not ask previously any physician; of those cases, 356 (17%) were hospitalized, 474 (25%) were either examined by specialist or treated and then discharged. In the remaining cases, no intervention was necessary. As a consequence, 58% of children were admitted without any clinically plausible reason. Parents' anxiety clearly played an important role in most cases. 840 children were addressed to the Emergency Department by a physician, 652 (22.3%) by the doctor in charge, 213 (32.7%) of which were sent back home by the doctor on duty, who did not think it necessary any treatment. Of the 120 (4.1%) children sent by different Emergency Departments, 95 (79.1%) were hospitalized. The reason why physicians addressed quite a large number of children to the Emergency Department, when they didn't need any intervention remain nucleo. Their diagnosis, in fact, agreed with those of the doctor on duty in 83% of cases. In conclusion, it is difficult to imagine a diagnostic or therapeutic problem which needs specific structures. Cooperative programs with physicians working in our region will be carried out in order to control, where possible, admission to Emergency Departments.     

Respiratory morbidity of hospitalized children with Trisomy 21

OBJECTIVE: To review the respiratory morbidity in children with Trisomy 21 admitted to a teaching hospital. METHODOLOGY: A retrospective chart review of 232 admissions to John Hunter Children's Hospital during a 6.5-year period (1991-98). The primary outcome measures included: (i) primary reason for admission, (ii) concomitant respiratory pathology, (iii) admission to the Intensive Care Unit (ICU), (iv) length of stay and (v) costs of admission. RESULTS: Fifty-four per cent of admissions were primarily for respiratory tract pathology, dominated by pneumonia, bronchiolitis and croup. Admission to the ICU was required for 10% of admissions, most commonly for pneumonia (10/23). Congenital heart disease (CHD) was present in 33% of patients. The median length of stay and cost of admission for a child with Trisomy 21 (without CHD) with common respiratory conditions such as bronchiolitis, asthma or pneumonia was two to three times greater than in patients without Trisomy 21. CONCLUSION: Lower respiratory pathology is most common cause for acute hospital admission in children with Trisomy 21. The presence of CHD did not influence admission rates to hospital. However, patients with CHD had longer lengths of stay, appeared to have more severe illness, were more likely to require admission to an ICU and were more likely to require ventilatory support.     

Psychological and psychosomatic diseases in puberty (therapy analyses and catamnestic results)

In a retrospective study we analysed the records of inpatient treated adolescents. It was of particular interest to investigate the "treated prevalence" of psychogenic problems in puberty and our therapeutic results. Within the 13-16 years old adolescent group we predominantly found the following disorders: depressive reaction, attempted suicide, but also a variety of psychosomatic disorders in respiratory, cardiovascular and musculo-skeletal system, and patients with anorexia nervosa. The structures and interactional profiles of the families with an adolescent patient are described. In family therapy, cooperation was especially difficult with parents of patients with an attempted-suicide. Despite the chronicity of the disorders in our sample our ratings of treatment results and the results of a follow-up questionnaire returned from the parents showed a good improvement. Out-patient therapy had worse results than in-patient therapy due to a drop-out rate of approximately 25-50%.     

Acute Poisoning in Children; Data of a Pediatric Emergency Unit

Objective

Acute Poisoning in children is still an important public health problem and represents a frequent cause of admission in emergency units. The epidemiological surveillance specific for each country is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.

Methods

The present retrospective study describes the epidemiology of accidental and suicidal poisonings in a pediatric population admitted to the Pediatric Emergency Department of Eskisehir Osmangazi University Hospital during the year 2009.

Findings

Two hundred eighteen children were reffered to the emergency department due to acute poisoning. 48.4% of patients were boys and 51.6% were girls. The majority of cases were due to accidental poisoning (73.3% of all patients). Drugs were the most common agent causing the poisoning (48.3%), followed by ingestion of corrosive substance (23.1%) and carbon monoxide (CO) intoxication (12.5%). Tricyclic antidepressant was the most common drug (11.7%). Methylphenidate poisoning, the second common drug. 262 patients were discharged from hospital within 48 hours.

Conclusion

Preventable accidental poisonings are still a significant cause of morbidity among children in developing countries. Drugs and corrosive agents are the most frequent agents causing poisoning.     

Unidad de niños con patología crónica compleja. Un modelo necesario en nuestros hospitales

Introduction

The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz.

Management of adolescents in pediatric hospitals. A national survey]

Hospital care of adolescents is a challenge for pediatric teams because of the characteristics and specific problems of this age group. METHODS: In 1996, a questionnaire was sent to all French public pediatric wards, 300 (i.e., 78%) of which participated. The goal of this survey was to investigate the facts and limitations encountered with hospitalization of patients 12 years and older. RESULTS: Data show that for more than half of the pediatric wards, the adolescent patient admission rate is higher than 10%. The upper age for hospitalization shows a shift towards adulthood, with 73% of the wards admitting adolescents up to 18 years of age. The main reasons for pediatric admission in this age group are somatic complaints, chronic diseases and suicide attempts. Psychosocial problems and psychiatric disorders are perceived as the most difficult to manage. However, a majority of pediatric wards appears to have an environment suitable for multidisciplinary networking. At the time of the survey, 39 wards (16%) had beds specifically destined for adolescents. These wards differed from others by their higher number of suicidal and anorexic inpatients. CONCLUSIONS: Our study shows that pediatric wards are in the avant-garde of adolescent hospital care and it brings new data on the various problems encountered in these patients. It stresses the special needs of pediatric teams today in the field of adolescent medicine and calls for the development of specific educational programs.     

Triage and white codes

AIM: In this paper, the authors analyse the type of accesses to the Emergency Department of the DEA of the G. Gaslini Institute defined by the triage as White Code, monitoring the outcome of said access. METHODS: This investigation was of retrospective type and lasted 6 months. It employed the fast track triage nursing system for the selection of patients. Independently of their age and sex and presenting pathology, the selected patients, at the moment of nursing triage, received the white code on the basis of EPM (emergency paediatric medicine) paediatric triage guidelines. A specially designed grid containing motivations was applied to those admitted to hospital on the basis of the Emergency Department judgement. The prospective investigation was facilitated by the computerised emergency department patient management system that has been operative in our department since June 2000. RESULTS: A total of 22400 white code accesses were recruited into the study; the admission percentage was 3.7% (89 patients). The most frequent reason for hospitalisation was the need to clinically classify a pathology that persisted without a complete response. CONCLUSION: This preliminary investigation will be pursued in the future with a collection of data for organisation type purposes and in order to contribute to greater hospital-local district integration.     

Evaluation and treatment of substance use problems among adolescents in emergency departments

This paper summarizes research on the epidemiology, screening, and brief treatment of adolescent substance abusers in emergency departments (EDs). The admission rate for emergency treatment of substance-related illness and injury for older adolescents is as high or higher than the admission rate for adult patients. Still, compared with adults, there has been less research and fewer systematic attempts to screen for and treat problematic substance use among adolescents presenting to EDs. Brief screening instruments can be quickly and easily administered from memory and recent research has shown that brief screens are effective for differentiating adolescents with substance use problems from their non-substance abusing peers in EDs. While few studies have tested brief interventions with adolescents in the ED, generally positive results have been found for reducing adolescent substance-related risk for injury. The paper concludes by discussing a general approach for establishing rapport with adolescents and conducting an assessment of substance use problems among ED-treated adolescents.     

Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission

OBJECTIVES: To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. METHOD: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa patients (mean age 15.6 years). They were all receiving treatment at a specialised Eating Disorder Unit and were at different points in the treatment programme. Admission during 6-9 month follow-up was recorded in 63 of these patients who had been admitted to the Unit. The other 7 patients were contacted by phone to determine if they had been hospitalised in another unit during the follow-up period. RESULTS: Patients who needed hospital admission during follow-up had higher mean scores at first evaluation on some of the EDI-2 scales and on the BDI, lower ANSOCQ scores and were more likely to have been outpatients at first evaluation. In the logistic regression analysis a low ANSOCQ score and being an outpatient at first evaluation were shown to be independent predictors of hospitalisation during follow-up. CONCLUSIONS: Low motivation to change, depressive symptomatology and some EDI-2 scales are related to the necessity of hospital admission in adolescent patients with anorexia nervosa.     

Measles lessons in an anti-vaccination era: public health is a social duty,not a political option

Background

Measles virus, member of the genus Morbillivirus in the family Paramyxoviridae, is a highly contagious human pathogen. An effective live-attenuated vaccine is available and its use has the potential to eradicate the disease from the human population. Although the vaccine was introduced in national vaccination schedules, several measles outbreaks have occurred because of insufficient vaccination coverage. Since early January 2017, a new outbreak of measles in Italy has been observed.

Methods

We analyzed all the patients admitted to the Emergency Department of Bambino Gesù Children Hospital of Rome from the 1st of January 2017 to the end of May 2017 and discharged with diagnosis of suspected or confirmed measles or admitted to the Pediatric and Infectious Disease Unit. For each confirmed case, demographic data, vaccination history, exposure to source case, clinical presentation, date of onset of symptoms, hospitalization, laboratory test results, complications and therapy were collected.

Results

From the 1st of January 2017 to the 31st of May 2017, we enrolled 139 patients who were conducted to the Emergency Department of Bambino Gesù Children’s Hospital because of measles: 33 patients were discharged with the diagnosis of suspected measles by clinical manifestations; 33 discharged with the diagnosis of confirmed measles by laboratory tests and 73 were admitted to the Pediatric and Infectious Disease Unit. Seven patients, who were exposed to mothers with measles, were admitted to receive treatment with Measles Immune Globulin intravenously. Among the 66 patients admitted to the hospital with measles, 31 cases (47%) occurred in unvaccinated individuals who were age-eligible for measles vaccination; 29 (44%) were infants too young to be vaccinated; only five patients (8%) received one dose of measles-containing vaccine.Out of the 66 patients, 35 (53%) developed complications. Acute respiratory failure was the most reported complications (20%). Death, due to multiorgan failure by measles, occurred in one 9-girl-year-age patient with genetic disorders who was unvaccinated.

Conclusions

Measles still represents a serious public health problem worldwide. Vaccination against measles is safe, effective, and cost-effective.High vaccination coverage (>95%) with two doses of measles vaccine is crucial to elimination. Health care professionals play an important role in vaccination uptake and prevention of measles spread during an outbreak.

     

Care of children in the emergency department: guidelines for preparedness

Children requiring emergency care have unique and special needs. This is especially so for those with serious and life-threatening emergencies. There are a variety of components of the emergency care system that provide emergency care to children that are not limited to children. With regard to hospitals, most children are brought to community hospital emergency departments (EDs) by virtue of their availability rather than to facilities designed and operated solely for children. Emergency medical services (EMS) agencies, similarly, provide the bulk of out-of-hospital emergency care to children. It is imperative that all hospital EDs and EMS agencies have the appropriate equipment, staff, and policies to provide high quality care for children. This statement provides guidelines for necessary resources to ensure that children receive quality emergency care and to facilitate, after stabilization, timely transfer to a facility with specialized pediatric services when appropriate. It is important to realize that some hospitals and local EMS systems will have difficulty in meeting these guidelines, and others will develop more comprehensive guidelines based on local resources. It is hoped, however, that hospital ED staff and administrators and local EMS systems administrators will seek to meet these guidelines to best ensure that their facilities or systems provide the resources necessary for the care of children. This statement has been reviewed by and is supported in concept by the Ambulatory Pediatric Association, American Association of Poison Control Centers, American College of Surgeons, American Hospital Association, American Medical Association, American Pediatric Surgical Association, American Trauma Society, Brain Injury Association Inc, Emergency Nurses Association, Joint Commission on Accreditation of Healthcare Organizations, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of EMTs, National Association of School Nurses, National Association of State EMS Directors, National Committee for Quality Assurance, and Society for Academic Emergency Medicine.     

Contraception and pregnancy in adolescence

OBJECTIVE: To review and discuss different contraceptive methods currently used by adolescents, and also discuss adolescent pregnancy, including the associated risks and the importance of prenatal care. METHODS: Review of literature and clinical experience with different contraceptive methods and with adolescent pregnancy. RESULTS: The oral contraceptive pill is the most common method used by teenagers due to its low failure rate and other non-contraceptive effects. Emergency contraception is a good option in cases of rape, unplanned sexual intercourse, condom rupture, nonuse of oral contraceptives during short intervals. In this case, the pill should be taken within 72 hours after the intercourse (preferably before 24 hours for best effect). Most problems related to adolescent pregnancy have a social or economic origin; however, some medical complications such as preterm labor and anemia are frequently reported. CONCLUSIONS: The use of male and female condoms combined with other contraceptive methods should be encouraged to prevent sexually transmitted diseases. If pregnancy is confirmed, prenatal care must be implemented as soon as possible in order to minimize the risks of complication and to allow for an effective multidisciplinary approach.     

Trends in paediatric sport- and recreation-related injuries: An injury surveillance study at the British Columbia Children's Hospital (Vancouver, British Columbia) from 1992 to 2005

BACKGROUND:

Sport- and recreation-related injuries are a major source of morbidity in the paediatric population. Long-term trends for these injuries are largely unknown.

METHODS:

A traumatic injury surveillance system (the Canadian Hospitals Injury Reporting and Prevention Program) was used to examine the demographics and trends of paediatric sports injuries in children who presented to or were directly admitted to the British Columbia Children’s Hospital (Vancouver, British Columbia) emergency department or intensive care unit from 1992 to 2005.

RESULTS:

Over the 14-year study period, there was a significant increase in sport- and recreation-related injuries among patients who presented to the British Columbia Children’s Hospital. Of 104,414 injuries between 1992 and 2005, 27,466 were related to sports and recreational activities. The number of sport-related injuries increased by 28%, while all-cause injuries did not change significantly. Males comprised 68% of the sport-related injuries, and both sexes displayed an increasing trend over time. Cycling, basketball, soccer and ice hockey were the top four injury-causing activities. The main body parts injured were the face, head and digits.

CONCLUSIONS:

Paediatric sports injuries significantly increased at the British Columbia Children’s Hospital over the 14-year study period. This is likely due to increased sport participation, increased risk associated with certain sports, or both. Trends in paediatric sports injury may be predicted by changes in popular media, possibly allowing prevention programs to help to avoid these injuries before they occur.     

Major Causes of Hospital Admission in Beta Thalassemia Major Patients in Southern Iran

Objective

Beta thalassemia major is a prevalent hereditary disease in Mediterranean region especially Iran. Early blood transfusion is necessary for most of the patients and frequent transfusion can cause various medical problems for the patients. The aim of this study was to find major causes of hospital admission in beta thalassemia major patients to reach the accurate preventive and therapeutic plans for these patients.

Methods

Four hundred twenty six patients were admitted to the Nemazee Hospital (the main University referral Hospital Center affiliated to Shiraz University of Medical Sciences in Fars Province, southern Iran) during 3 years period (January 2007 to January 2010). A questionnaire was filled containing age, gender, hemoglobin level, frequency of blood transfusions, deferoxamine injection, cause of hospital admission and hospital course.

Findings

The mean age of patients was 11.28 years. The mean serum ferritin level was 1820±749 µg/lit. Two hundred fifty five (59.75%) patients were male and 171 (40.25%) patients were female. The top five most prevalent causes of hospital admission were splenectomy (21.8%), infections (19.9%), congestive heart failure (19.0%), diabetes mellitus (13.4%), and Liver biopsy (11.5%). (P=0.0002)

Conclusion

Results of this study revealed that infections and complications due to iron overload are major causes of hospital admission in beta thalassemia major patients.     

The use of clinical score to estimate the severity of an acute attack of asthma

OBJECTIVE: To identify patients with acute asthma who require intensive care, using a clinical score.METHODS: Retrospective analysis of 299 patients who were admitted to the hospital for acute asthma, between 1993 and 1996. Two groups were selected: group I (GI) with 26 patients admitted to the Intensive Care Unit; group II (GII) with 52 patients admitted to the Emergency Room, matched by age and sex with those of GI. A clinical score to assess the groups had the following items: heart rate, respiratory rate, retractions, cyanosis, alertness level, previous treatment, previous hospitalization, and duration of attack. The score ranged from 0 to 2 points for each of those, summing up 11 points.RESULTS: The clinical parameters that discriminated well the 2 groups were: retractions (p<0.001), cyanosis (p<0.01) and alertness level (p<0.005). Through a discriminate analysis of the clinical score components, 22/26 patients were recognized as GI and 40/52 patients were recognized as GII, showing an accuracy of 85% and 77% respectively for GI and GII.CONCLUSION: The clinical score was useful to discriminate patients with severe attack of asthma who might require intensive care, and should be employed at hospital admission.     

Forensic laboratory evidence in sexually abused children and adolescents

OBJECTIVES: To determine if forensic laboratory evidence could be recovered from alleged sexual abuse victims more than 24 hours after the event and to determine if age or historical factors could be used to determine the need for forensic evidence collections. DESIGN: Retrospective study of hospital records matched with forensic evidence reports from the Arkansas State Crime Laboratory, Little Rock. SETTING: The emergency department at Arkansas Children's Hospital, Little Rock. PARTICIPANTS: Eighty children (aged <12 years) and adolescents (aged > or =12 years) who presented to the emergency department within 72 hours of an alleged event of sexual abuse or assault with genital contact. MAIN OUTCOME MEASURES: Cases positive for semen were correlated with age of the victim and post-event length of time to presentation to the emergency department. RESULTS: Of the 80 subjects, 16 had positive findings for semen. All 16 subjects who tested positive for semen presented to the emergency department less than 24 hours after the alleged abuse or assault event (P<.001). Of the 16 subjects who tested positive, 13 (81%) were adolescents. None of the prepubertal children had semen recovered from any body site; semen was recovered only from clothing or linen in those 3 children. CONCLUSIONS: Forensic evidence collections from body sites in child and adolescent rape patients are unlikely to yield positive results for semen (1) more than 24 hours after the event and (2) when taken from prepubertal patients. Consideration should be given to amending guidelines regarding forensic evidence collections in child and adolescent sexual abuse or assault victims.     

Medical and social factors associated with the admission and discharge of acutely ill children

AIM: To examine medical and sociodemographic factors involved in acute paediatric admission. To compare outcome of admission with factors present at time of admission. METHODS: Prospective questionnaire based study of 887 consecutive emergency general paediatric admissions to five Yorkshire hospitals during two separate three week periods in summer and winter. MAIN OUTCOME MEASURES: Discharge diagnosis, length of stay. RESULTS: Most admissions (53%) occurred "out of hours" with a peak during the evening. Two thirds (64%) of patients were under 3 years of age and clinical problems varied with age. Self referral via an accident and emergency department occurred in one third and was more likely after a fit in older children and in more socioeconomically deprived children. The most frequent presenting problems were breathing difficulty (24%), fit (16%), and feverish illness (15%). One quarter (24%) were discharged within 24 hours and 61% spent, at most, one night in hospital. Length of stay was shorter for night admissions and longer for children with a discharge diagnosis of asthma. Although most children had mild, self limiting illnesses, serious illness was subsequently found in 13% and could not be predicted from the presenting problems. CONCLUSIONS: Current demand on emergency paediatric admission is mainly from young children with mild self limiting illnesses who spend one night or less in hospital. Changes in delivery of care to acutely ill children must take account of the pattern and nature of presenting problems and be rigorously audited to ensure that improvements in the health of children continue.