RESUMO
Children less than 13 years of age account for 27% of the case mix at the Emergency Department (ED) of the Port Moresby General Hospital (PMGH). The ED is busy, usually overcrowded, understaffed and under-equipped, resulting in less than optimal patient management. Children are a highly vulnerable group of patients and have the potential to deteriorate rapidly. This prospective descriptive study aimed to assess the adequacy of management of children presenting to the ED between 1600 and 0800 hours. A standardized and individually administered questionnaire was used to assess the management of 107 children. The median age was 13 months, interquartile range 6-36 months, with a male to female ratio of 1.5:1. The most frequent diagnoses were pneumonia/bronchiolitis, diarrhoea, malaria, asthma and febrile convulsions. Three-quarters of the sample were classified as being triage 1 and 2, ie, requiring either immediate life-saving treatment or treatment within 30 minutes to an hour of presentation. Median and interquartile ranges for time from arrival to assessment were 60 (15-110) minutes for triage 1, and 60 (30-121) minutes for triage 2 patients. Time from assessment to management was 5 (5-45) minutes for triage 1 and 40 (30-63) minutes for triage 2 patients. Treatment instituted was appropriate in 93% of cases but the drug dosage was incorrect in 26%. 49 children (46%) were admitted to the wards either directly or following further observation in the ED or Children's Outpatient Department, the rest being treated and discharged, except for one child with probable septicaemia who died following a prolonged and unattended wait in the ED. Management was assessed as adequate in only 40% of cases. The major causes of inadequate management were delayed treatment, under- or over-dosing, under- or over-treatment, omission of appropriate investigations, misdiagnosis and failure of judicious consultation with the paediatric team. Many patients were nursed on the floor. Recommendations emanating from the study include ensuring adequate staffing levels and the training of all staff working in ED in the rapid identification of sick children to improve triage and subsequent management.
