Can Non-Invasive Capnography and Integrated Pulmonary Index Contribute to Patient Monitoring in the Pediatric Emergency Department?

2021 ◽  
Author(s):  
Ramazan Gurlu ◽  
Ozlem Tolu Kendir ◽  
Omer Baspinar ◽  
Nilgun Erkek
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Emergency Room ◽  
Respiratory Rate ◽  
Large Scale ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Life Saving ◽  
Significant Difference ◽  
End Tidal

Abstract Objectives Noninvasive capnography (NICG) devices can measure oxygen saturation, end-tidal carbon dioxide (EtCO2), respiratory rate, heart rate values and integrated pulmonary index (IPI). This study aimed to evaluate patients who were monitored using NICG for various indications in a pediatric emergency department and to determine its contribution to patient management in the pediatric emergency department (PED). Methods In this study, children aged <18 years who had been monitored with a NICG at the PED in our university between August 2018-May 2019 were evaluated. Of them 48 patients' file records and monitored capnography parameters such as heart rate, respiratory rate, blood pressure, capillary refill time, Glasgow Coma Score, SpO2, EtCO2, IPI recorded in the forms were reviewed. Results Patients most often presented to the emergency room due to seizures (35.4%), change in consciousness (22.9%), other neurological reasons (18.8%) with %50 were female. Seizure treatment(16.7%), circulatory–respiratory support(16.7%), and antiedema treatments(6.3%) were required for 39.5% patients as life-saving interventions, and 72.9% patients were hospitalized. Patients with low IPI(<8) values at the beginning and decreasing IPI (<8) measurements within monitoring period needed more life-saving treatments(p=0.005 and p=0.001, respectively). Low IPI values of the patients during monitoring showed a significant difference in the decision to be hospitalized(p=0.048). Conclusions The results of the present study indicate that monitoring with NICG in the pediatric emergency room can be an important early indicator in establishing clinical prediction. The study particularly points out that the IPI value can be a guide in decisions regarding life-saving treatment and hospitalization. Among the capnographic data of these patients who had a change in consciousness IPI values those measured at the beginning and within the monitorizarion period showed a significant correlation with low GCS (<8) (r=0.478, p=0.001 and r=0.456, p=0.02, respectively). Prospective comprehensive large scale studies are needed to examine the use of NICG and IPI in routine PED practice for various indications.

scholarly journals Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial (Preprint)

2021 ◽  
Author(s):  
Silvia Rossi ◽  
Silvano Junior Santini ◽  
Daniela Di Genova ◽  
Gianpaolo Maggi ◽  
Alberto Verrotti ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Emergency Room ◽  
Randomized Clinical Trial ◽  
Effect Size ◽  
Salivary Cortisol ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cortisol Levels ◽  
The Impact

BACKGROUND Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. OBJECTIVE This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. METHODS This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen <i>d</i>-based effect size correlation (<i>r</i>). RESULTS A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (<i>r</i>=0.75). Cortisol levels decreased more in girls (<i>r</i>=0.92) than in boys (<i>r</i>=0.57). CONCLUSIONS SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. CLINICALTRIAL ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909

scholarly journals The appropriateness of referrals to a pediatric emergency department via a telephone health line

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 139-148 ◽  
Author(s):  
Tawfik Al-Abdullah ◽  
Amy C. Plint ◽  
Alyson Shaw ◽  
Rhonda Correll ◽  
Isabelle Gaboury ◽  
...  
Keyword(s):  
Emergency Department ◽  
Resource Use ◽  
Primary Outcome ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Lengths Of Stay ◽  
Triage Category ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Explicit Criteria

ABSTRACT Objective: We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral. Methods: A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED. Results: Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p &lt; 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes. Conclusion: There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.

Alcohol use in adolescence: 5 years admissions at a pediatric emergency department

2018 ◽  
Vol 32 (4) ◽  
Author(s):  
Marlene Rodrigues ◽  
Teresa Pontes ◽  
Juliana Almeida ◽  
Alexandra Estrada ◽  
Susana Carvalho
Keyword(s):  
Emergency Department ◽  
Alcohol Use ◽  
Pediatric Emergency ◽  
Heavy Episodic Drinking ◽  
High Rate ◽  
Easy Access ◽  
Pediatric Emergency Department ◽  
Exact Test ◽  
Significant Difference ◽  
The Mean

AbstractObjectiveTo characterize the profile and pattern of alcohol consumption in adolescents, admitted with acute alcoholic intoxication (AAI) at a pediatric emergency department of North Portugal.MethodsRetrospective descriptive study of adolescents aged between 10 and 17 years, admitted with AAI between 2012 and 2016. The following variables were evaluated: age, gender, drinking context, quantity and type of alcohol, Glasgow Coma Scale (GCS), previous episodes, associated injuries, transport to the emergency department, other drug consumption, blood alcohol level (BAL), blood glucose level, treatment and orientation. The χ2/Fisher’s exact test and t-Student test were performed (p < 0.05).ResultsA total of 180 adolescents with AAI presented. The majority of adolescents were older than 15 years old (71%) and 3% were younger than 14 years old. The mean age was 15.9 years [standard deviation (SD) 1.1 years] and 65% were males. The most common type of alcohol consumed was distilled drinks (60%). Recurrent alcohol use was identified in 7% and binge drinking was reported in 37% of patients. The mean BAL was 1.58 g/L (SD 0.6 g/L) and there were other drug consumptions (mainly cannabinoids) observed in 11% of patients. After emergency department discharge, 17% were followed at hospital consultation. There was no significant difference between boys and girls or between BAL and injuries or other drugs consumption.ConclusionThis study confirms a high rate of alcohol use among adolescents, in particular “heavy episodic drinking”, revealing an easy access to alcohol at this age. The integration of alcohol use prevention programs in community and education systems should be encouraged and implemented in every adolescent consultation.

Exploring the Effect of Mindfulness on Burnout in a Pediatric Emergency Department

2021 ◽  
pp. 216507992110044
Author(s):  
Kei U. Wong ◽  
Lauren Palladino ◽  
Melissa L. Langhan
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Large Scale ◽  
Maslach Burnout Inventory ◽  
Pediatric Emergency ◽  
Personal Accomplishment ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Before And After

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.

scholarly journals Epinephrine autoinjector prescription filling after pediatric emergency department discharge

2021 ◽  
Vol 42 (2) ◽  
pp. 142-146
Author(s):  
Joanna S. Cohen ◽  
Chisom Agbim ◽  
Michael Hrdy ◽  
Mary E. Mottla ◽  
Monika K. Goyal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Private Insurance ◽  
Sociodemographic Factors ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Factors Associated ◽  
Outpatient Prescription ◽  
Significant Difference ◽  
Bivariable Analysis ◽  
Emergency Department Discharge

Background: There are known racial and socioeconomic disparities in the use of epinephrine autoinjectors (EAI) for anaphylaxis. Objective: To measure the rates of EAI prescription filling and identify patient demographic factors associated with filling rates among patients discharged from the pediatric emergency department. Methods: This was a retrospective observational cohort study of all patients discharged from a pediatric emergency department who received an outpatient prescription for an EAI between January 1, 2018, and October 31, 2019. The rates of prescription filling were calculated, and multivariable logistic regression was performed to identify sociodemographic factors associated with prescription filling. Results: Of 717 patients included in the analysis, 54.8% (95% confidence interval {CI}, 51.1%‐58.5%) filled their prescription. There were no significant associations between EAI fill rates and patient age or sex. In bivariable analysis, non-Hispanic white patients were more likely to fill EAI prescriptions compared with non-Hispanic Black patients (odds ratio [OR] 1.89 [95% CI, 1.11‐3.20]), and patients with in-state Medicaid were significantly less likely to fill EAI prescriptions compared with those patients with private insurance (OR 0.69 [95% CI, 0.48‐0.98]). However, after multivariable adjustment, there was no significant difference in filling by age, insurance status, or race or ethnicity. Conclusions: Only approximately half the patients had their EAI prescriptions filled after discharge. Filling rates did not vary by sociodemographic characteristics.

Assessing Somatization and Psychosocial Impairment in the Pediatric Emergency Department

2010 ◽  
Author(s):  
Zorash Montano ◽  
Neda Safvati ◽  
Angela Li ◽  
Ilene Claudius ◽  
Jeffrey I. Gold
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Psychosocial Impairment
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