The impact of COVID-19 on paediatric emergency department visits. A one-year retrospective study

Abstract Objectives We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation. Methods Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann–Whitney U-tests, and regression analysis. Results Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: −1.90 [−3.37, −0.43]) or being discharged home (−1.78 [−3.04, −0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03). Conclusions iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage. Clinical trials registration ClinicalTrials.gov: NCT02326623.

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Retrospective study showed that palpitations with tachycardia on admission to a paediatric emergency department were related to cardiac arrhythmias

Acta Paediatrica ◽

10.1111/apa.14486 ◽

2018 ◽

Vol 108 (2) ◽

pp. 328-332 ◽

Cited By ~ 1

Author(s):

Marco Bobbo ◽

Stefano Amoroso ◽

Gianluca Tamaro ◽

Valentina Gesuete ◽

Biancamaria D'agata Mottolese ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Cardiac Arrhythmias ◽

Paediatric Emergency Department ◽

Paediatric Emergency

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Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children’s Hospital in Nice

BMJ Open ◽

10.1136/bmjopen-2021-056476 ◽

2022 ◽

Vol 12 (1) ◽

pp. e056476

Author(s):

Antoine Tran ◽

Anne-Laure Hérissé ◽

Marion Isoardo ◽

Petri Valo ◽

Anne-Marie Maillotte ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Care Pathway ◽

Emergency Department Visits ◽

Secondary Outcome ◽

Medical Visit ◽

Paediatric Emergency Department ◽

Factors Associated ◽

Paediatric Emergency

ObjectiveTo evaluate compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.DesignProspective, single centre.SettingFourth biggest PED in France in terms of attendance (CHU-Lenval).Patients280 patients of whom 249 were included in the statistical analysis.Main outcome measuresThe primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviewsResults77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS’s postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS’s postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).ConclusionPostbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.Trial registration numberThe study bears the clinical trial number NCT02863627.

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Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Singapore Medical Journal ◽

10.11622/smedj.2016105 ◽

2015 ◽

Vol 57 (06) ◽

pp. 307-313 ◽

Cited By ~ 5

Author(s):

GL Goh ◽

P Huang ◽

MC Kong ◽

SP Chew ◽

S Ganapathy

Keyword(s):

Emergency Department ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

One Year

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1342 Evaluating the impact of antimicrobial stewardship interventions in a UK paediatric emergency department

10.1136/archdischild-2021-rcpch.571 ◽

2021 ◽

Author(s):

Jathusa Peethamparam ◽

Sanjay Patel ◽

David James

Keyword(s):

Emergency Department ◽

Antimicrobial Stewardship ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

The Impact

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Analgesia for extremity fractures in the paediatric emergency department

Proceedings of Singapore Healthcare ◽

10.1177/2010105820915731 ◽

2020 ◽

Vol 29 (2) ◽

pp. 108-112

Author(s):

Siew Ming Tan ◽

Yong-Kwang Gene Ong ◽

Jen Heng Pek

Keyword(s):

Emergency Department ◽

Pain Score ◽

Lower Limb ◽

Key Management ◽

Current Practice ◽

Paediatric Emergency Department ◽

Patient Demographics ◽

Paediatric Emergency ◽

The Mean ◽

The Impact

Background: Extremity fractures are an important and common presentation at the Paediatric Emergency Department (PED). Provision of analgesia is a key management principle, but it is often suboptimal. Although there is an increase in awareness of this issue, the impact on current practice is not known. We aimed to review the current practice of providing analgesia for extremity fractures in the PED. Objective: Our objective was to determine the utilisation, adequacy and timeliness of analgesia provided for these patients. Methods: A retrospective study was carried out from November to December 2017. Patients with a diagnosis of extremity fracture involving the upper or lower limb were included. Information about patient demographics, diagnosis, pain score, analgesia use and clinical progress were collected for analysis. Results: There were 101 cases. The mean age was 8.5±4.2 years old, and 62 (61.4%) patients were male. There were 76 (75.3%) cases of fractures involving the upper limb, and 25 (24.7%) cases of fractures involving the lower limb. The mean pain score at presentation was 3.3±2.3. Analgesia was administered to only 10 (9.9%) patients, with oral paracetamol ( n=5; 5.0%) being the most common medication administered. The median time between arrival in the PED to analgesia administration was 69 minutes (range 25–328 minutes). Conclusions: Despite the increase in awareness, analgesia for these patients remains underutilised, inadequate and delayed. Further efforts at pain assessment, analgesia selection and administration are necessary to improve the provision of analgesia for these patients.

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To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006605 ◽

2017 ◽

Vol 27 (7) ◽

pp. 521-528 ◽

Cited By ~ 4

Author(s):

Laurie Smith ◽

Yajur Narang ◽

Ana Belen Ibarz Pavon ◽

Karl Edwardson ◽

Simon Bowers ◽

...

Keyword(s):

Emergency Department ◽

Natural Experiment ◽

Care Pathway ◽

Waiting Times ◽

Sensitivity Analyses ◽

Antibiotic Prescribing ◽

Paediatric Hospital ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

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