Paediatric utilization of a general emergency department in a developing country

Abstract

Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean ± SD 6.9 ± 5.6 y); 43% were aged ≤4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft‐tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED.

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade

“…That is, infants are those with higher demand for the HEM emergency department, confirming data from several studies that assessed the utilization the different health care services (primary, secondary, and tertiary) by preschool children, especially from 0 to 2 years old (18)(19)(20)(21) . According to the collected data, it was found that most patients assisted by the HEM during the study period came from high densely-populated neighborhoods.…”

Nonemergent emergency department visits under the National Health Insurance in Taiwan

“…These personal traits may contribute to the perceived urgency of their illness, and hence their preference to use ED for their NE problems. Other researchers found that ED visits by children were for common pediatric illnesses [30,32] and non-traumatic injuries suggesting the use of EDs for primary care [33][34][35]. Parental anxiety may have also been a deciding factor especially after office hours [30].…”

Consultas ambulatorias pediátricas atendidas en el Servicio de Urgencia de un hospital universitario

“…El espectro de motivos de consulta descrito para cada rango etario y el bajo perfil de riesgo de los pacientes pediátricos en la admisión al SU son concordantes con los datos reportados en la literatura nacional e internacional 5,14,[17][18][19][20][21] . Sin embargo, las consultas por lesiones traumáticas e intoxicaciones fueron menos frecuentes en nuestro estudio (4,4% y 0,2%, respectivamente) comparado con otros estudios internacionales (20 a 40%) 5,19,20,22 , aunque similar a lo descrito en una cohorte de pacientes pediátricos atendidos en el Hospital Roberto del Río 14 .…”

“…Sin embargo, las consultas por lesiones traumáticas e intoxicaciones fueron menos frecuentes en nuestro estudio (4,4% y 0,2%, respectivamente) comparado con otros estudios internacionales (20 a 40%) 5,19,20,22 , aunque similar a lo descrito en una cohorte de pacientes pediátricos atendidos en el Hospital Roberto del Río 14 . Esta diferencia podría estar determinada en parte por el hecho de que nuestra institución no es un centro de referencia de trauma y haber excluido del análisis a los pacientes atendidos en el SU de traumatología.…”

“…La tasa de hospitalización fue sustancialmente menor en nuestro estudio comparado con la literatura nacional y extranjera (4% vs 4,4% a 25%) a pesar de tener un perfil de severidad (ESI) similar en la admisión 5,14,17,19,20,22,23 ; esta disparidad podría estar determinada por varios factores epidemiológicos, estructurales y administrativos. El HCPUC no es un centro de referencia de trauma y tiene una capacidad relativamente pequeña de camas pediátricas, lo que podría determinar la menor tasa de admisión.…”