Bed Utilization and Overcrowding in a High-Volume Tertiary Level Pediatric Emergency Department.

OBJECTIVE: To measure bed utilization rate and overcrowding in a high-volume tertiary level pediatric emergency department (ED) and correlate with outcome. METHODS: All children beyond neonatal age attending the 22-bedded emergency were prospectively enrolled from February to December, 2019. Number of daily admissions, boarders, discharges, ward transfers, length of stay (LOS) and unfavorable outcomes (care discontinuation and deaths) were recorded. Daily bed occupancy rate (BOR) was calculated and correlated with unfavorable outcome. RESULTS: A total of 17,463 children visited the ED during the study period. The median (IQR) daily attendance and admission rate was 58 (51,65) and 22 (17,26) patients, respectively. The median (IQR) number of boarders and BOR was 48 (40-58) and 218% (181-263%), respectively. The median (IQR) LOS was 42.7 (23-71.4) hours. Unfavorable outcome correlated positively with number of boarders and BOR (P<0.001). CONCLUSIONS: Overcrowding of the ED was associated with increased frequency of care discontinuation and mortality. This data calls for systemic changes to tackle overcrowding.

Clinical profile and juvenile arthritis damage index in children with juvenile idiopathic arthritis: A study from a tertiary care center in south India.

AIM: This study was designed to determine the clinical profile of juvenile idiopathic arthritis (JIA) and its morbidity using the juvenile arthritis damage index (JADI) score at a tertiary care center in northern Kerala and to compare with data from India and abroad. METHODS: A hospital-based cross-sectional study was carried out over a period of one and half years from January 2011 to July 2012. Clinical and laboratory profiles and morbidity were assessed. RESULTS: There were 62 children (mean age 8.9 ± 3.8 years) with JIA during this period with a median duration of disease of 24 months (2-151 months). The most common subgroup was polyarticular JIA (n = 26; 41.9%) followed by systemic JIA (sJIA) (n = 20; 32.3%), oligoarticular JIA (n = 15; 24.2%) and enthesitis-related arthritis (n = 1; 1.6%). The most common joints involved at presentation were the knee (38.7%) followed by the ankle (25.8%). Weights and heights were less than the fifth centile in 25.8% and 11.3%, respectively, being most affected in sJIA. The frequencies of articular and extra-articular morbidities were highest in sJIA and showed negative correlation with age at onset and positive correlation with the duration of illness. Macrophage activation syndrome was diagnosed in 50% of sJIA with a mortality of 33.3%. We experienced lower frequency of articular (30.6% vs. 60.7%) and extra-articular damage (24.2% vs. 39.3%), growth failure (19.3% vs. 68.5%) and pubertal delay (4.8% vs. 20.2%) compared to another study from north India. CONCLUSIONS: Our study shows lower frequency of morbidity in JIA; probably related to a better healthcare system facilitating early diagnosis and treatment in this part of the country.