ABSTRACT
Background@#Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. @*Methods@#This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year.To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. @*Results@#In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. @*Conclusion@#A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies.Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.
ABSTRACT
Background@#Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. @*Methods@#This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year.To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. @*Results@#In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. @*Conclusion@#A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies.Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.
ABSTRACT
Purpose@#In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data. @*Methods@#From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score ( 2, overweight or obese). @*Results@#A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively. @*Conclusion@#BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.
ABSTRACT
Purpose@#Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea. @*Methods@#We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed. @*Results@#A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001). @*Conclusion@#Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.
ABSTRACT
Objective@#Urinary tract infection (UTI) is a significant issue in young febrile patients due to potential long-term complications. Early detection of UTI is crucial in pediatric emergency departments (PEDs). We developed a tool to predict UTIs in children. @*Methods@#Clinical data of patients <24 months of age with a fever and UTI or viral infection were extracted from the fever registry collected in two PEDs. Stepwise multivariate logistic regression was performed to establish predictors of identified eligible clinical variables for the derivation of the prediction model. @*Results@#A total of 1,351 patients were included in the analysis, 643 patients from A hospital (derivation set) and 708 patients from B hospital (validation set). In the derivation set, there were more girls and a lower incidence of a past history of UTI, older age, less fever without source, and more family members with upper respiratory symptoms in the viral infection group. The stepwise regression analysis identified sex (uncircumcised male), age (≤12 months), a past history of UTI, and family members with upper respiratory symptoms as significant variables. @*Conclusion@#Young febrile patients in the PED were more likely to have UTIs if they were uncircumcised boys, were younger than 12 months of age, had a past history of UTIs, or did not have families with respiratory infections. This clinical prediction model may help determine whether to perform urinalysis in the PED.
ABSTRACT
BACKGROUND@#A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries.@*METHODS@#A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries.@*RESULTS@#Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51–147.72).@*CONCLUSION@#The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery.
ABSTRACT
BACKGROUND: A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries.METHODS: A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries.RESULTS: Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51–147.72).CONCLUSION: The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery.
Subject(s)
Child , Humans , Caregivers , Cross-Sectional Studies , Emergencies , Hospitalization , Korea , Logistic Models , Lower Extremity , Odds Ratio , Play and Playthings , Risk Factors , Social Control, Formal , Wounds and InjuriesABSTRACT
Background@#In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. @*Methods@#This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. @*Results@#A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). @*Conclusions@#Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.
ABSTRACT
Background@#Previous studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage. @*Methods@#This was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class. @*Results@#During the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant (P < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state (P = 0.502) and the case of air transport (P = 0.468). @*Conclusion@#Down-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered.
ABSTRACT
Objective@#Trampoline-related injuries have increased in South Korea. However, little research has been conducted on this topic. This study aimed to show the characteristics of pediatric trampoline-related injuries in South Korea and to investigate the factors associated with admission. @*Methods@#A retrospective, cross-sectional study was conducted using data from South Korea’s Emergency Department-based Injury In-depth Surveillance registry for dates between January 2011 and December 2016. All patients under 18 years of age with trampoline-related injuries were included. We divided the patients into two groups based on whether they were admitted or discharged. Odds ratios with 95% confidence intervals were calculated to evaluate the factors associated with hospital admission for pediatric trampoline-related injuries. @*Results@#A total of 2,745 patients were enrolled and the incidence increased over time (P for trend<0.01). The most common injury site was the lower extremity (45%). Fracture was the most frequent diagnosis (34.3%). Compared to the discharge group, the adjusted odds ratios (95% confidence intervals) for hospital admission were 3.53 (1.73–7.17) for the teenage group, 2.62 (1.82–3.77) for upper extremity injuries, 18.48 (7.95–42.95) for fractures, 2.28 (1.35–3.86) for falls, and 2.04 (1.15–3.60) for collisions. @*Conclusion@#Trampoline-related injuries in children have increased over time in South Korea. Most occur in children under the age of 12 years, but children between the ages of 13 and 18 years are at a higher risk for hospitalization. Also, injuries of the upper extremity, fracture, falling, and collision are risk factors for admission. Preventive strategies are needed to reduce trampoline-related injuries in children.
ABSTRACT
BACKGROUND@#A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries.@*METHODS@#A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries.@*RESULTS@#Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51–147.72).@*CONCLUSION@#The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery.
ABSTRACT
Purpose@#Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. @*Methods@#This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. @*Results@#Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 103 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. @*Conclusion@#Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings.
ABSTRACT
OBJECTIVE: The use of computed tomography (CT) in pediatric patients has decreased since the association between radiation and cancer risk has been reported. However, in adolescent patients being treated as adult patients, there has been a high incidence of CT use in emergency departments (EDs). Thus, this study aimed to evaluate the CT use in adolescent patients with complaints of headache or abdominal pain in the general and pediatric EDs of the same hospital.METHODS: A retrospective chart review of patients aged 15 to 18 years, who presented with headache or abdominal pain at the general and pediatric EDs of Seoul National University Hospital from January 2010 to December 2014, was conducted.RESULTS: A total of 407 adolescent patients with complaints of headache and 980 with abdominal pain were included in this study. The adolescent patients in the general ED were more likely to undergo CT scans than those in the pediatric ED, with both patients having headache (42.4% vs. 20.5%, respectively, P<0.001) and abdominal pain (29.0% vs. 18.4%, respectively, P<0.001). There was no statistical difference in the rates of positive CT findings between the general and pediatric EDs. The frequency of visits to the general ED was associated with high rates of CT use in adolescent patients with complaints of headache (odds ratio, 3.95; 95% confidence interval, 2.01 to 7.77) and those with abdominal pain (odds ratio, 1.76; 95% confidence interval, 1.18 to 2.64).CONCLUSION: The ED setting influences the use of CT on adolescent patients, and a child-friendly environment could reduce the radiation risks.
Subject(s)
Adolescent , Adult , Humans , Abdominal Pain , Emergencies , Emergency Service, Hospital , Headache , Incidence , Radiation Exposure , Retrospective Studies , Seoul , Tertiary Care Centers , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: This study examined the role of superficial vein surgery in patients with combined superficial venous reflux and segmental popliteal vein reflux. METHODS: We retrospectively reviewed 42 limbs in 38 patients with combined superficial venous reflux and segmental popliteal vein reflux who underwent saphenous vein ablation between January 2014 and February 2017. Patients underwent outpatient follow-up duplex ultrasonography at 3, 6, and 12 months postoperatively. Resolution of deep vein reflux was defined as reversed blood flow in a popliteal segment for less than 1.0 second and a decrease in the reflux time of more than 20% of the preoperative reflux time. RESULTS: The mean follow-up period was 9 months (range, 3–23 months). Saphenous vein ablations were performed by stripping in 24 limbs and radiofrequency ablation in 18 limbs. Preoperative segmental popliteal vein reflux resolved in 21 of the 42 limbs (50%). CONCLUSION: This study demonstrated that superficial venous surgery corrected segmental popliteal vein reflux in 50% of limbs with combined superficial venous reflux and segmental popliteal vein reflux. Other prospective studies are necessary to elucidate the etiology of the non-reversible cases.
Subject(s)
Humans , Catheter Ablation , Extremities , Follow-Up Studies , Outpatients , Popliteal Vein , Prospective Studies , Retrospective Studies , Saphenous Vein , Ultrasonography , Veins , Venous InsufficiencyABSTRACT
OBJECTIVE: Many studies have proposed reducing unnecessary use of computed tomography (CT), and ongoing studies in pediatric populations are aiming to decrease radiation dosages whenever possible. We aimed to evaluate the long-term changes in the utilization patterns of CT and ultrasound (US) in pediatric emergency departments (PEDs). METHODS: This retrospective study reviewed the electronic medical data of patients who underwent CT and/or US in the PED of a tertiary referral hospital from 2000 to 2014. We compared the changes in utilization patterns of brain and abdominal CT scans in pediatric patients and analyzed changes in abdominal US utilization in the PED. RESULTS: During the study period, 196,371 patients visited the PED. A total of 12,996 brain and abdominal CT scans and 12,424 abdominal US were performed in the PED. Comparison of CT use in pediatric patients before and after 2007 showed statistically decreasing trends after 2007, expressed as the coefficient values of the differences in groups. The numbers of brain and abdominal CT scans showed a significant decreasing trend in children, except for abdominal CT in adolescents. The abdominal US/CT ratio in the PED showed a statistically significant increase (2.68; 95% confidence interval, 1.87 to 3.49) except for the adolescent group (5.82; 95% confidence interval, -2.06 to 13.69). CONCLUSION: Overall, CT use in pediatric patients has decreased since 2007. Pediatric US use has also shown a decreasing trend; however, the abdominal US/CT ratio in pediatric patients showed an increasing trend, except for adolescents.
Subject(s)
Adolescent , Child , Humans , Brain , Diagnostic Imaging , Emergencies , Emergency Service, Hospital , Radiation Dosage , Retrospective Studies , Tertiary Care Centers , Tomography, X-Ray Computed , UltrasonographyABSTRACT
OBJECTIVE: The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). METHODS: This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40–S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse’s pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. RESULTS: A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P < 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. CONCLUSION: ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.
Subject(s)
Humans , Analgesics , Education , Electronic Health Records , Emergencies , Emergency Service, Hospital , Extremities , International Classification of Diseases , Pain Management , Pain Measurement , Prescriptions , Quality Improvement , Retrospective Studies , TriageABSTRACT
The frequency of procedures in the emergency department has increased with changes in the medical environment and the demands of the times. Especially in children, sedation and analgesia are often inevitable due to the difficulty in seeking cooperation. Procedural sedation and analgesia is essential for successful completion of procedure, but the medical personnel who perform it must be prepared for complications caused by medications. Safe procedural sedation and analgesia requires well-trained medical personnel and well-prepared equipment, including appropriate patient assessments and choice of medications, faithful monitoring, and resuscitation. This review focuses on understanding of sedation processes, patient evaluation, medications, and monitoring.
Subject(s)
Child , Humans , Analgesia , Anesthesia , Conscious Sedation , Deep Sedation , Emergencies , Emergency Service, Hospital , ResuscitationABSTRACT
PURPOSE: To develop a clinical scoring system for children with presumed appendicitis who visit the emergency department. METHODS: A registry based-retrospective study was conducted in the pediatric emergency department between September 2015 and December 2016. Patients aged 4 to 17 years who had a > 1 of 5 Likert scale for possibility of appendicitis were included. Multiple logistic regressions based on Akaike information criterion were performed using variables regarding clinical features and inflammatory markers to develop the clinical scoring system. RESULTS: A total of 233 patients were included, and 93 (39.9%) had the final diagnosis of appendicitis. The final model with the lowest Akaike information criterion (171.7) consisted of 5 variables, including vomiting (1 point), absence of watery diarrhea (1 point), duration of symptoms ≤ 3 days (1 point), rebound tenderness (1 point), and white blood cell count > 10.0 × 109/L (2 points). If the clinical score was ≥ 4 of 6 points, the area under the receiver operating characteristic curve was 0.78 (95% confidence interval, 0.71-0.86) with a 78.9% sensitivity, 66.7% specificity, positive and negative predictive values of 70.0% and 76.2%, respectively, and positive and negative likelihood ratios of 2.4 and 0.3, respectively. CONCLUSION: The 5-item clinical scoring system shows a fair performance for prediction of pediatric appendicitis. This simple tool could be applied to predict the pediatric appendicitis, and to avoid the use of potentially unnecessary computed tomography.
Subject(s)
Child , Humans , Appendicitis , Decision Support Techniques , Diagnosis , Diarrhea , Emergency Service, Hospital , Leukocyte Count , Leukocytes , Logistic Models , Pediatrics , ROC Curve , Sensitivity and Specificity , VomitingABSTRACT
OBJECTIVE: To investigate the contributing factors of carpal tunnel syndrome (CTS), electrodiagnostic and ultrasonographic findings of median nerve, and median nerve change after exercise in wheelchair basketball (WCB) players. METHODS: Fifteen WCB players with manual wheelchairs were enrolled in the study. Medical history of the subjects was taken. Electrodiagnosis and ultrasonography of both median nerves were performed to assess CTS in WCB players. Ultrasonographic median nerves evaluation was conducted after wheelchair propulsion for 20 minutes. RESULTS: Average body mass index (BMI) and period of wheelchair use of CTS subjects were greater than those of normal subjects. Electrodiagnosis revealed CTS in 14 of 30 hands (47%). Cross-sectional area (CSA) of median nerve was greater in CTS subjects than in normal subjects at 0.5 cm and 1 cm proximal to distal wrist crease (DWC), DWC, 1 cm, 2 cm, 3 cm, and 3.5 cm distal to DWC. After exercising, median nerve CSAs at 0.5 cm and 1 cm proximal to DWC, DWC, and 3 cm and 3.5 cm distal to DWC were greater than baseline CSAs in CTS subjects; and median nerve CSAs at 1 cm proximal to DWC and DWC were greater than baseline CSAs in normal subjects. The changes in median nerve CSA after exercise in CTS subjects were greater than in normal subjects at 0.5 cm proximal to DWC and 3 cm and 3.5 cm distal to DWC. CONCLUSION: BMI and total period of wheelchair use contributed to developing CTS in WCB players. The experimental exercise might be related to the median nerve swelling around the inlet and outlet of carpal tunnel in WCB athletes with CTS.
Subject(s)
Humans , Athletes , Basketball , Bays , Body Mass Index , Carpal Tunnel Syndrome , Electrodiagnosis , Electromyography , Hand , Median Nerve , Ultrasonography , Wheelchairs , WristABSTRACT
Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the ‘real practice (RP)-level,’ while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the ‘simulation (S)-level.’ A total of 22,841 patients were triaged during the study period. The hospitalization rate according to RP-PedKTAS levels exhibited a significant correlation with the expected hospitalization rate suggested by the Pediatric Canadian Triage and Acuity Scale (CTAS) (P = 0.002), whereas the S-PedKTAS levels did not (P = 0.151). Compared with the previously reported pediatric CTAS level-specific hospitalization rate and intensive care unit (ICU) admission rate, RP-PedKTAS was significantly correlated with both hospitalization rate and ICU admission rate (P = 0.001 and P = 0.012, respectively). However, S-PedKTAS showed no significant correlation in both (P = 0.267 and P = 0.188, respectively). The determination of triage levels based on clinical decision rather than the direct application of abnormal initial vital signs to PedKTAS is more accurate in predicting the hospitalization rate and ICU admission rate.