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Objective@#In September 2018, the traffic law revision has enforced all passengers in cars to wear seatbelts. Our study aims to investigate the effects of this law revision on fellow passengers involved in car accidents by considering their seatbelt-wearing rate and severity score. @*Methods@#This study is a retrospective observational study. Data were collected from the Emergency Department-based Injury in-depth Surveillance (for the years 2017 and 2019), Korea Disease Control and Prevention Agency. Candidates were patients who visited emergency rooms (ERs) of 23 hospitals from January to December in the years 2017 and 2019. Patients under the age of 15 years or without Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) data or having accidents on highways were excluded. @*Results@#The total number of patients who visited ERs during the study periods was 91,506 and 14,806 in 2017 and 2019, respectively, and were included in our study. There were more fellow female passengers than male passengers during both the study periods: 5,559 in 2017 (67.9%) and 4,341 in 2019 (66.8%). Compared to 52.2% in 2017, the rate of wearing seatbelts increased to 54.5% in 2019. However, after adjusting for age, sex, use of ambulance, injury time, alcohol use, type of road, and counterpart, multivariate logistic regression revealed that compared to the 2017 group, the odds ratio of severe injuries in the 2019 group was 1.10 (95% confidence interval, 0.98-1.24). @*Conclusion@#Increased rate of wearing seatbelts after imposing the traffic law revision was not satisfactory. Therefore, it is necessary to tighten regulations on fellow passengers without seat belts and improve awareness through public relations.
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Purpose@#We aimed to investigate the changing trends in intentional drug poisoning among pediatric and adolescent patients over the past 10 years. @*Methods@#A retrospective study was conducted on patients younger than 20 years who visited an academic hospital emergency department (ED) in Incheon, Korea, from January 2011 through December 2020. The study focused on patients who responded with “self-harm or suicide” in the ED-based Injury In-depth Surveillance, and whose injury mechanism was drug poisoning. Exclusion criteria were unintentional injuries and the ingestion of substances other than drugs. To describe the trend over the decade, we used the number of events/100,000 ED annual visits of the database. @*Results@#A total of 3,388 cases with a median age of 17 years (interquartile range, 15-18 years) were included. The most frequently ingested drugs were acetaminophen (27.8%), followed by benzodiazepines (15.2%), antidepressants (14.1%), other sedatives and hypnotics (13.4%), and antipsychotics (8.3%). As for the events/100,000 ED annual visits, benzodiazepines showed the biggest increase, from 7.6 to 80.2 cases. Similarly, antidepressants increased from 10.2 to 71.1 cases, and antipsychotics from 3.6 to 53.7 cases. @*Conclusion@#Intentional drug poisoning has increased over the past 10 years, particularly in benzodiazepines, antidepressants, and antipsychotics. It is advisable to establish injury prevention strategies according to patients’ characteristics and ingested drugs.
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Purpose@#The aim of this study was to investigate the epidemiologic features of pediatric dental injury according to age groups using Korean national data. @*Methods@#We reviewed the data from 2015 to 2019 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. We included children aged 18 years or younger with the International Classification of Disease, 10th Revision codes related to dental injury. Other or combined codes were excluded. The children were classified by age groups: infants (< 1 year), preschoolers (2-6), schoolers (7-12), and adolescents (13-18). As per the age groups, we compared the clinical characteristics, injury event profiles, and outcomes. @*Results@#The study population (n = 33,020) consisted of 8,900 infants (27.0%), 15,705 preschoolers (47.6%), 5,295 schoolers (16.0%), and 3,120 adolescents (9.4%). Their median age was 3 years (interquartile range, 1-7), and boys accounted for 64.2%. The most common mechanism, type of activity, and place were slip down (14,274 [43.2%]), daily activity (23,777 [72.0%]), and home (19,980 [60.5%]), respectively. Among the injury types, soft tissue injury was most common (24,357 [73.8%]). As for the outcomes, 32,841 (99.5%) children were discharged, and 332 (1.0%) children had severe injury. As the age increased, the frequencies changed as follows. As for the place and type, household injury and soft tissue injury decreased while outdoor injury, such as road traffic injury, and tooth fracture increased (P < 0.001). As for the type of activity, injuries related to exercise/sports and education increased (P < 0.001). Of the sports activity, ball sports increased while kickboard/cycle decreased (P < 0.001). @*Conclusion@#Using the epidemiologic features of pediatric dental injury, it is advisable to establish injury prevention strategies according to the age groups.
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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.
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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.
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Objective@#Personal mobility vehicles (PMV) have been used widely as a means of replacing bicycles in recent yearsbecause of their convenience and high economic efficiency. On the other hand, accidents related to PMV are alsoincreasing, but there have been few studies in this area. This study examined the factors that increase the severity ofdamage and determine the characteristics of the PMV compared to the accidents on a bicycle. @*Methods@#Retrospective observational studies were performed. The variables related to the accident were collected andanalyzed for patients who visited the emergency room due to a PMV and bicycle accident. Multivariate logistic regressionanalysis was used to determine the factors affecting the severity of the patients. The odds ratios were calculated andcompared between injuries related to PMV and bicycles. @*Results@#A total of 1,124 patients (bicycles 1,017, PMV 107) were enrolled in this study. In multivariate regression analysis,the severity of PMV was higher (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.06-2.83) than that of a bicycle.The factors affecting the severity of the patients were age (OR, 1.02, 95% CI, 1.01-1.03), alcohol use (OR, 1,70; 95% CI,1.04-2.70), ambulance transport (OR, 2.46; 95% CI, 1.78-3.40), and wearing a helmet (OR, 2.06; 95% CI, 1.36-3.13). @*Conclusion@#PMV showed higher severity of damage than a bicycle. The PMV, which is a new transportation means, isinsufficient for the prevention of safety compared to bicycles where driving regulations and wearing protective equipmentare common. Additional studies on the precise mechanisms of injury and damage are expected to prevent accidents andreduce their severity.
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Objective@#No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED. @*Methods@#This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance. @*Results@#This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667–0.791] vs. 0.681 [0.613–0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613–0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762–0.867) and 0.806 (0.754–0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00–1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02–1.11; P=0.002). @*Conclusion@#Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/ septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.
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Purpose@#The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. @*Methods@#We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. @*Results@#Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). @*Conclusion@#In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.
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Purpose@#Methods for suicide attempt are largely divided into poisoning and non-poisoning, which differ in clinical features and severity. We aimed to investigate the clinical features of adolescents with suicide attempt and factors associated with poor outcomes from the 2 methods. @*Methods@#A retrospective study was conducted on adolescents (10-18 years) who visited the emergency department after suicide attempt from 2011 through 2018. The adolescents were divided into the poisoning and non-poisoning groups. We analyzed the differences of clinical features and outcomes between the 2 groups. Poor outcomes were defined as hospitalization to the intensive care unit or death. Factors associated with poor outcomes were investigated using multivariable logistic regression. @*Results@#Of 4,335 adolescents in total, 2,134 (49.2%) were categorized as the poisoning group. In this group, the adolescents with poor outcomes used acetaminophen most frequently (26.5%), followed by sedative or antipsychotics (22.3%). In the non-poisoning group, those with the outcomes used fall from height (73.2%) most commonly, followed by hanging (21.0%). The factors associated with the outcomes were age (for increment of 1 year; odds ratio, 1.11; 95% confidence interval, 1.02-1.22) in the poisoning group, and being boys (1.34; 1.03-1.73) and non-use of alcohols (2.87; 1.73-4.74) in the non-poisoning group. @*Conclusion@#In adolescents who used poisoning for suicide attempt, increasing age is associated with poor outcomes. The outcomes are associated with being boys and non-use of alcohols in those who used non-poisoning methods.
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Objective@#Doctors or public health doctors at the nearest institution to a disaster scene often have to treat the casualties at the scene. Therefore, disaster medical education is necessary for medical students and doctors, but such education is not properly implemented. This study investigated the status of disaster medical education in Korean medical schools and the professors' thoughts on the appropriateness and necessity of disaster medical education. @*Methods@#A survey was conducted on working-level professors in charge of student education in emergency medicine in 40 medical schools. The survey asked the professors the current status of disaster medical education at each school and the professors' thoughts on the appropriateness and necessity of disaster medical education. @*Results@#Thirty-seven professors (92.5%) responded to the survey. Twenty-seven schools (73.0%) had a regular curriculum of disaster medicine. Disaster drills were conducted at 34 training hospitals (91.9%), while students of 10 schools (29.4%) were officially participating in the drill. Of the responders, 31 (83.8%) responded that disaster medicine is necessary for clinicians. Thirty-seven professors (100%) thought disaster medical education was necessary for medical students, and 20 (54.1%) of them responded that their schools did not provide adequate disaster medical education. @*Conclusion@#Many schools did not have a proper course on disaster medical education. Disaster medical education is necessary for medical students, but such education is not properly implemented.
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Purpose@#The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. @*Methods@#We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. @*Results@#Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). @*Conclusion@#In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.
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Purpose@#Methods for suicide attempt are largely divided into poisoning and non-poisoning, which differ in clinical features and severity. We aimed to investigate the clinical features of adolescents with suicide attempt and factors associated with poor outcomes from the 2 methods. @*Methods@#A retrospective study was conducted on adolescents (10-18 years) who visited the emergency department after suicide attempt from 2011 through 2018. The adolescents were divided into the poisoning and non-poisoning groups. We analyzed the differences of clinical features and outcomes between the 2 groups. Poor outcomes were defined as hospitalization to the intensive care unit or death. Factors associated with poor outcomes were investigated using multivariable logistic regression. @*Results@#Of 4,335 adolescents in total, 2,134 (49.2%) were categorized as the poisoning group. In this group, the adolescents with poor outcomes used acetaminophen most frequently (26.5%), followed by sedative or antipsychotics (22.3%). In the non-poisoning group, those with the outcomes used fall from height (73.2%) most commonly, followed by hanging (21.0%). The factors associated with the outcomes were age (for increment of 1 year; odds ratio, 1.11; 95% confidence interval, 1.02-1.22) in the poisoning group, and being boys (1.34; 1.03-1.73) and non-use of alcohols (2.87; 1.73-4.74) in the non-poisoning group. @*Conclusion@#In adolescents who used poisoning for suicide attempt, increasing age is associated with poor outcomes. The outcomes are associated with being boys and non-use of alcohols in those who used non-poisoning methods.
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Objective@#Doctors or public health doctors at the nearest institution to a disaster scene often have to treat the casualties at the scene. Therefore, disaster medical education is necessary for medical students and doctors, but such education is not properly implemented. This study investigated the status of disaster medical education in Korean medical schools and the professors' thoughts on the appropriateness and necessity of disaster medical education. @*Methods@#A survey was conducted on working-level professors in charge of student education in emergency medicine in 40 medical schools. The survey asked the professors the current status of disaster medical education at each school and the professors' thoughts on the appropriateness and necessity of disaster medical education. @*Results@#Thirty-seven professors (92.5%) responded to the survey. Twenty-seven schools (73.0%) had a regular curriculum of disaster medicine. Disaster drills were conducted at 34 training hospitals (91.9%), while students of 10 schools (29.4%) were officially participating in the drill. Of the responders, 31 (83.8%) responded that disaster medicine is necessary for clinicians. Thirty-seven professors (100%) thought disaster medical education was necessary for medical students, and 20 (54.1%) of them responded that their schools did not provide adequate disaster medical education. @*Conclusion@#Many schools did not have a proper course on disaster medical education. Disaster medical education is necessary for medical students, but such education is not properly implemented.
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PURPOSE: Computed tomography (CT) scan is an effective modality for detecting fatal traumatic brain injury. However, radiation exposure from CT can increase the risk of cancer, and children are more vulnerable to radiation than adults. We aimed to investigate the effect of introducing the Pediatric Emergency Care Applied Research Network (PECARN) rule to the emergency department (ED).METHODS: Medical records of children younger than 2 years with minor head injury who visited ED from January 2013 to June 2015 were reviewed. We started the education of radiation hazard and the PECARN rule in January 2014. The children were divided into pre- and post- education groups. The baseline characteristics, CT rate, and clinical outcomes were analyzed. The safety and efficacy of CT were defined as patients who received head CT scan per those experiencing clinically important traumatic brain injury (ciTBI) and patients without CT scan per those without ciTBI, respectively.RESULTS: Of 911 patients, 360 (39.5%) visited during the post-education period. Median age was 16.0 months (interquartile range, 11.0–20.0 months), and boys accounted for 58.5%. CT rate was reduced from 40.5% to 12.8% (P < 0.001). There was no difference in ciTBI rates between the two groups (1.3% vs. 1.7%, P = 0.622). The safety was 100% in both periods and the efficacy increased from 52.9% to 88.7%.CONCLUSION: We have seen a significant decrease in CT rate through the education of the PECARN rule. After its introduction, CT use was reduced, and the efficacy was improved without decrease in the safety.
Subject(s)
Adult , Child , Humans , Brain Injuries , Brain , Craniocerebral Trauma , Education , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Head , Medical Records , Pediatrics , Radiation Exposure , Tomography, X-Ray ComputedABSTRACT
Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.
Subject(s)
Female , Humans , Abdominal Pain , Bezoars , Emergency Service, Hospital , Intestinal Obstruction , Intussusception , Pica , Tail , TrichotillomaniaABSTRACT
OBJECTIVE: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. METHODS: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. RESULTS: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36–6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03–0.81). CONCLUSION: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.
Subject(s)
Advanced Cardiac Life Support , Cardiopulmonary Resuscitation , Defibrillators , Education , Emergencies , Emergency Medicine , Hand , Heart Arrest , Incidence , Intensive Care Units , Retrospective Studies , Sodium BicarbonateABSTRACT
PURPOSE: To investigate the age group characteristics of children who visited the emergency department with acute poisoning by ingestion. METHODS: We reviewed children under 19 years who visited the emergency department for acute poisoning by ingestion from 2012 to 2017. The children were divided into 3 age groups; infants (0-1 years), preschoolers (2-5 years), and schoolers (6-18 years). Clinical characteristics, intentional ingestion, involved substances (drugs, household products, artificial substances, and pesticides), decontamination and antidote therapy, and outcomes of the 3 age groups were compared. We also performed multivariable logistic regression analysis to identify factors associated with hospitalization. RESULTS: A total of 622 children with acute poisoning by ingestion were analyzed. Their annual proportions to overall pediatric emergency patients ranged from 0.3% to 0.4%. Age distribution showed bimodal peaks at 0-2 years and 15-17 years. The infants showed lower frequency of girls, intentional ingestion, ingestion of drugs, performance of decontamination and antidote therapy, and hospitalization than 2 older groups (P < 0.001). Most decontamination, antidote therapy, and hospitalization occurred in the schoolers (P < 0.001). The most frequently reported substances were household cleaning substances in the infants (18.2%), antihistamines in the preschoolers (15.8%), and analgesics in the schoolers (37.5%). The factors associated with hospitalization were intentional ingestion (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 2.85-17.61; P = 0.001) and schoolers (aOR, 2.33; 95% CI, 1.10-7.53; P = 0.031; compared with infants). Only 1 in-hospital mortality was found in a boy aged 2 years who ingested methomyl. CONCLUSION: Infants may experience non-intentional ingestion, ingestion of non-pharmacologic substances (especially household cleaning substances), discharge without decontamination and antidote therapy more frequently than older children. Thus, we need age group-specific, preventive and therapeutic plans for children with acute poisoning.
Subject(s)
Adolescent , Child , Female , Humans , Infant , Male , Age Distribution , Analgesics , Decontamination , Eating , Emergencies , Emergency Service, Hospital , Epidemiology , Family Characteristics , Histamine Antagonists , Hospital Mortality , Hospitalization , Household Products , Logistic Models , Methomyl , Odds Ratio , PoisoningABSTRACT
Given that Kawasaki disease (KD) can cause cardiac complications, it is crucial to diagnose and treat the disease in the emergency department. We report a case of a 10-year-old girl who presented to the emergency department with cervical lymphadenopathy and fever. The initial diagnosis was retropharyngeal abscess based on computed tomography findings, but antibiotic therapy failed and she was subsequently diagnosed with KD. After 3 doses of intravenous immunoglobulin along with methylprednisolone and methotrexate, she was discharged on hospital day 21. The cervical lymphadenopathy suggesting retropharyngeal abscess might be an early sign of incomplete or intravenous immunoglobulin-resistant KD.
Subject(s)
Child , Female , Humans , Diagnosis , Emergency Service, Hospital , Fever , Immunoglobulins , Lymphatic Diseases , Methotrexate , Methylprednisolone , Mucocutaneous Lymph Node Syndrome , Neck Pain , Retropharyngeal Abscess , VasculitisABSTRACT
PURPOSE: This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy. METHODS: This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis. RESULTS: Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05–1.81; diarrhea: OR, 1.94; 95% CI, 1.08–3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78–3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11–1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19–1.82; P<0.05) were associated with the delayed diagnosis. CONCLUSION: To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.