The pediatric disease spectrum in emergency departments across Pakistan: data from a pilot surveillance system

Abstract

BackgroundThere is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.MethodsThrough the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of over one million ED encounters.ResultsOf 25,052 children registered in Pak-NEDS (10% of all patients seen): 61% were male, 13% under 5 years, while almost 65% were between 10 to < 16 years. The majority (90%) were seen in public hospital EDs. About half the patients were discharged from the EDs, 9% admitted to hospitals and only 1.3% died in the EDs. Injury (39%) was the most common presenting complaint, followed by fever/malaise (19%) and gastrointestinal symptoms (18%). Injury was more likely in males vs. females (43% vs. 33%; p < 0.001), with a peak presentation in the 5-12 year age group (45%).ConclusionsPediatric patients constitute a smaller proportion among general ED users in Pakistan. Injury is the most common presenting complaint for children seen in the ED. These data will help in resource allocation for cost effective pediatric ED service delivery systems. Prospective longer duration surveillance is needed in more representative pediatric EDs across Pakistan.

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department

“…Respiratory distress can present in a variety of ways, ranging from increased respiratory rate, cough and wheezing to intercostal recessions and cyanosis [ 5 – 7 ]. Respiratory illnesses are highly prevalent in Low and Middle Income Countries (LMICs), such as Pakistan and a common cause of ED presentation [ 2 – 4 , 8 ].…”

Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

“…1740 (30) 506 (22) 936 (42) 68 (15) 95 3739 4418 (22) 78 ( (30) 566 (25) 757 (34) 165 (37) 81 3227 3116 (20) 97 (28) Information NA 509 (9) 211 (9) 176 (8) 30 730 127 813 1642 (12) Ethnicity, n (%) Brahmin and Chhetri 2573 (45) 944 (41) 1072 (48)…”

“…222 49113 4433 (38) 40 49149 (42) Janajati 2546 (44) 1068 (47) 932 (42) 193 (43) 117 4644 5031 (38) 161 (46) Dalit 507 (9) 219 (10) 193 (9) 30 719 78 ( Presentation to ED, n (%)* 08:00-16:00 weekdays 1037 (24) 481 (28) 322 (19) 96 2837 2023 (38) 24 (40) 54 2216:00-08:00 or holidays 465 (27) 567 (34) 76 (22) 56 3019 3217 (28) 67 (27) ICU or OT or Referred 341 (8) 126 7117 726 826 1418 307 1221 ( Other complaints included musculoskeletal, neurology, urinary, cardiovascular diseases or complaints, psychology, and other general complaints.…”

“…In our study injuries and suspected infections dominated the presenting complaints in children <16 year of age. We have identified 6 studies [22][23][24][25][26][27] that have described the disease spectrum of pediatric emergency patients in Asian LMICs, and some patterns are remarkably similar across studies. Broadly, infections and injuries are dominating in unselected pediatric emergency patients, and typically children in these EDs are young with a median age 2 to 7 years in studies including children up to 13 or 18 years.…”

Clinical Pharmacists in Pediatric Units

“…The preventable infectious disease spectrum are the major cause of death and disability in South Asia, contributing to 3.7 million deaths in children, over 60% of whom are under 5 years old. Studies on the pediatric ED disease spectrum in developing countries show that majority of chief complaints and final diagnoses are infection-related (up to 64%) [5]. Even though Global under-five mortality rate dropped 53% since 1990, the WHO estimates that approximately 5.9 million children under age five died in 2015, 16 000 every day, and respiratory infections especially pneumonia contributes about 13% [6].…”