Children with chronic conditions in a pediatric emergency department.

The objective of this study was to describe the use of a pediatric emergency department (PED) by children with chronic conditions. The study design was retrospective and descriptive in an urban tertiary care pediatric hospital setting. We reviewed 8561 visits to a PED over a three-month time period. Two thousand twenty-four (24%) of the visits were by children with one or more chronic conditions. There were no interventions. The mean age of the patients was 4.9 years, and 61% were male. Thirty-one percent of the patients sought care between 8 AM and 5 PM Monday through Friday. Five subspecialty areas accounted for 86% of the chronic conditions seen: asthma (43%), neurology (15%), hematology/oncology (14%), neurosurgery (10%), and cardiology (4%). Twenty-eight percent of the chronically ill patients were admitted as compared to 11% of the nonchronically ill patients (P < 0.001). One percent of the chronically ill patients were admitted to the intensive care unit as compared to 0.03% of the nonchronically ill patients (P < 0.0001). It was concluded that children with chronic conditions account for one-quarter of all PED visits. Sixty-nine percent of those visits were made during evening/ nighttime hours or on the weekend. A relatively large percentage of these children were admitted. The pediatric emergency physicians provide an important service to both the children with chronic conditions and the subspecialists who care for them. PEDs may need to refine emergency department systems to serve this group of patients as efficiently and effectively as possible.

Comprehensive care of the child with a chronic condition. Part 1. Understanding chronic conditions in childhood.

Understanding the care of children with chronic illnesses and disabilities is an important part of the practice of pediatrics. Children with special health care needs and their families benefit from the support which comprehensive, coordinated, accessible, and responsive services provide. Although the primary care pediatrician is often most appropriate to serve as the overall coordinator of such services, many challenges to providing such care exist. Part 2, "Primary Care Management," will suggest guiding principles and management structures that allow the pediatrician to respond most effectively over time to the needs of children with chronic conditions and their families.

Triage decisions in child care for sick children.

Child-care centers for children with mild, acute communicable, and noncommunicable illnesses are beginning to evolve. Few states have enacted regulations concerning the policies and procedures under which child-care centers for sick children operate. These centers should have policies regarding the triage and care of ill children that promote the safety of all children and staff at the center. As part of the establishment of regulations for the Michigan Department of Social Services, Lansing, a triage model has been developed that provides a means of standardizing the screening process used to admit mildly ill children to such centers. We present pilot guidelines for use by center personnel, discuss considerations inherent in formulating triage policy for child-care centers for sick children, and provide a starting point for those attempting to standardize regulations governing child-care centers for sick children.