Pediatric somatization in the emergency department: assessing missed opportunities for early management

CJEM ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 331-337
Author(s):  
Punit Virk ◽  
Dzung X. Vo ◽  
Jacob Ellis ◽  
Quynh Doan
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Considerable Proportion ◽  
Symptom Duration ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Early Management ◽  
Health Related

ABSTRACTObjectiveSomatization is a common phenomenon that can severely complicate youths’ functioning and health. The burden of somatization on pediatric acute care settings is currently unclear; better understanding it may address challenges clinicians experience in effectively caring for somatizing patients. In this study, we estimate the prevalence of somatization in a pediatric emergency department (ED).MethodsWe conducted a retrospective cross-sectional study of visits for non-critical, non-mental health-related concerns (n = 150) to a quaternary-level pediatric ED between July 2016 and August 2017. Demographic and clinical visit details were collected through chart review and used by two reviewing clinicians to classify whether each visit had a “probable,” “unclear” (possible), or “unlikely” somatizing component.ResultsApproximately 3.33% (n = 5) of youth displayed probable somatization, and an additional 13.33% (n = 20) possibly experienced a somatizing component but require additional psychosocial and visit documentation to be certain. Longer symptom duration and multiple negative diagnostic tests were associated with a higher likelihood of either probable or possible somatization.ConclusionsA considerable proportion of non-mental health-related visits may involve a somatizing component, indicating the burden of mental health concerns on the ED may be underestimated. A higher index of suspicion for the possibility of somatization may support clinicians in managing somatizing patients.

scholarly journals Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study

2021 ◽  
Vol 18 (4) ◽  
pp. 1882
Author(s):  
Kate Emond ◽  
Melanie Bish ◽  
Michael Savic ◽  
Dan I. Lubman ◽  
Terence McCann ◽  
...  
Keyword(s):  
Mental Health ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Considerable Proportion ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Related ◽  
Manage Mental ◽  
Manage Mental Health

Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.

scholarly journals Under Prescription of Epinephrine to Medicaid Patients in the Pediatric Emergency Department

2019 ◽  
Vol 6 ◽  
pp. 2333794X1985496
Author(s):  
Sylvia Owusu-Ansah ◽  
Oluwakemi Badaki ◽  
Jamie Perin ◽  
Martha Stevens ◽  
Jennifer Anders ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Considerable Proportion ◽  
Pediatric Emergency Department ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adherence Data ◽  
Auto Injector ◽  
Medicaid Prescription

Objective. To describe pediatric Medicaid patients with pediatric emergency department (PED) visits for anaphylaxis who received epinephrine auto-injector (EAI) prescriptions in the ED versus those who did not; and to compare patients who filled their prescriptions versus those who did not. Methods. We conducted a cross-sectional study of Medicaid patients aged 0 to 21 years presenting to 2 PEDs, with symptoms meeting the National Institute of Allergy and Infectious Diseases criteria for anaphylaxis, between July 2012 and July 2014. Results. We identified 86 patients across the 2 hospitals with a confirmed diagnosis of anaphylaxis in the PED. Of these, 55 (64%, 95% confidence interval [CI] = 53% to 74%) received a prescription for an EAI during their ED visit. Forty-two (68%; 95% CI = 56% to 80%) received a prescription for EAI in Hospital 1 versus 13 (54%; 95% CI = 33% to 74%) in Hospital 2. Medicaid prescription fill rates were available for Hospital 1. Of the 42 who received an EAI prescription, 36 (86%; 95% CI = 75% to 96%) filled these prescriptions with Medicaid. Of the 20 (32%) out of 62 patients with anaphylaxis who did not receive prescriptions for an EAI, only 5 had previously filled prescriptions for epinephrine. Conclusion. Previous Medicaid patient prescription adherence data suggested that these patients would have a low EAI prescription fill rate. We found Medicaid patients who received prescriptions for an EAI after the ED visit for anaphylaxis filled them; however, a considerable proportion of anaphylaxis visits had no EAI prescription provided at discharge.

scholarly journals Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews

2020 ◽  
Author(s):  
Joyce B Der ◽  
Daniel J Grint ◽  
Clement T Narh ◽  
Frank Bonsu ◽  
Alison D Grant
Keyword(s):  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Symptom Duration ◽  
Hiv Status ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Tb Treatment ◽  
Symptom Screening ◽  
Night Sweats

Abstract Background We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana. Methods In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF. Results We enrolled 581 participants (median age 33 years [IQR: 24–48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08–23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24–17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result. Conclusion Opportunities for early identification of people with TB are being missed in health facilities in Ghana.

scholarly journals Does the cancer patient's disease stage matter? A comparative study of caregivers' mental health and health related quality of life

2012 ◽  
Vol 10 (3) ◽  
pp. 189-196 ◽  
Author(s):  
Ellen Karine Grov ◽  
Berit Taraldsen Valeberg
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Cancer Patients ◽  
Cross Sectional Study ◽  
Disease Stage ◽  
Cross Sectional ◽  
Health Related Qol ◽  
Health Related ◽  
The Impact

AbstractObjective:Cancer affects both patients and their caregivers. Caregiver burden may change during different stages of the patients' cancer trajectory. Limited research has focused on the impact of being a caregiver, assessed by the caregiver's mental health and quality of life (QOL) during the curative and the palliative phases of the patient's disease. The aim of this study is to compare caregivers of cancer patients during the curative and a palliative phases with respect to their mental health and health-related QOL.Method:This descriptive, cross-sectional study combines data from two studies. The first group consists of caregivers of patients with cancer in the late palliative phase and the second group consists of caregivers of outpatients with cancer who suffer from pain and/or use analgesics. Data were collected by means of standardized measures and analyzed with descriptive statistics.Results:Based on this material, no significant differences in mental health and health- related QOL were revealed for caregivers of cancer patients in the palliative and the curative phases, respectively. Neither education level in the caregivers, nor the patients' functional status influenced caregivers' mental health or QOL. Younger caregivers seem to have better physical QOL.Significance of results:Being caregivers of cancer patients seems to have a similar pattern of impact on caregivers' mental health and quality of life regardless of the patient's disease stage. We share some reflections about the way in which the cancer stage is divided and the appropriateness of such selection for measuring caregivers' mental health and QOL. Additionally, we discuss the use of generic instruments for measuring specific contexts and particular samples.

scholarly journals The Effect of the COVID-19 Pandemic on the Pediatric Emergency Department Flow

2021 ◽  
pp. 1-25
Author(s):  
Andrea Rivera-Sepulveda ◽  
Timothy Maul ◽  
Katherine Dong ◽  
Kylee Crate ◽  
Talia Helman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Admission Rate ◽  
Severity Index ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chief Complaints

ABSTRACT Objective: To determine how the early stages of the COVID-19 pandemic affected the utilization of the Pediatric Emergency Department (PED). Methods: Cross-sectional study of PED visits during January through April, 2016-2020. Data included: total PED visits, emergency severity index (ESI), disposition, chief complaint, age (months), time from first Provider to Disposition (PTD), and PED length of stay (PED-LOS). P-value <0.01 was statistically significant. Results: In total, 67,499 visits were reported. There was a significant decrease in PED visits of 24-71% from March to April 2020. Chief complaints for fever and cough were highest in March 2020; while April 2020 had a shorter mean PED-LOS (from 158 to 123 minutes), an increase of admissions (from 8% to 14%), a decrease in ESI 4 (10%), and an increase in ESI 3 (8%) (p<0.001). There was no difference in mean monthly PTD time. Conclusions: Patient flow in the PED was negatively affected by a decrease in PED visits and increase in admission rate that may be related to higher acuity. By understanding the interaction between hospital processes on PEDs and patient factors during a pandemic, we are able to anticipate and better allocate future resources.

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