Emergency Intubation For Paediatric Patients At The Emergency Departments

Abstract Introduction: Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. Methods: This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. Results: Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; P<0.01) and those with trauma-related presentations (6,669 [37.0%] vs 108,822 [15.9%]; P<0.01). The mortality of paediatric patients was low overall but significantly higher in general EDs (39 [0.2%] vs 32 [0.005%]; P<0.01). Seizure, asthma/bronchitis/bronchiolitis, allergic reaction, cardiac arrest and burns were the top 5 diagnoses that accounted for 517 (56.1%) of all emergent (P1) cases seen at general EDs. Conclusion: General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment. 3 Keywords: Attendance, emergency, epidemiology, health services, paediatrics

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Determinants related to the risk of using ED among paediatric patients receiving home care services

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.876 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Scattaglia ◽

S Campagna ◽

G Politano ◽

M Dalmasso ◽

V Dimonte ◽

...

Keyword(s):

Mortality Rate ◽

Home Care ◽

Emergency Departments ◽

Musculoskeletal Diseases ◽

Home Care Services ◽

Cross Sectional ◽

Care Services ◽

Paediatric Patients ◽

Ed Visits

Abstract Introduction Pediatric home care services (PHC) are recommended to avoid hospital visits or readmission in children with chronic or complex conditions and to reduce the use of emergency departments. It would be useful to know the association of sociodemographic, clinical and health supply factors with Emergency Department (ED) access by patients receiving PHC. Methods A cross sectional retrospective cohort study was held from 2012 to 2017 in Pediatric home care services in Italy. Participants are children aged 0-18 years receiving pediatric home care services. Collected data are: sociodemographic variables (sex, age, presence or absence of an unfamiliar caregiver); distance from the ED in minutes; clinical variables (mortality rate at home, mortality rate in the ED, pathology responsible for the PHC activation and pathology determining the ED access); health supply variables (PHC proposed duration as stated by the proponent, subjects directing the patient to the ED, place of discharge after ED access, and arrival time to the ED). Results A total of 1236 PHC events contributed to 769 ED accesses. Receiving PHC services after hospital discharge (RR:1.26) and longer duration of charge-taking significantly increased the risk of experiencing ED access. The RR significantly decreased among children >5 years-of-age (RR:0.84; RR:0.62; RR;0.57; in 5-9; 10-14; 15-18 years respectively) and among children with neoplastic (RR:0.7), respiratory (RR:0.69), trauma (RR:0.4) or musculoskeletal diseases (RR:0.31) at first evaluation. Conclusions Confirming that ED accesses are issue present among children receiving home care services, this study has the main strength of demonstrating which risk factors are associated with ED accesses by children using home care services. Knowledge of them is necessary in order to implement adequate prevention strategies on both management and quality of care. Key messages Determinants associated with the risk of using emergency departments among paediatric patients receiving integrated paediatric home care services. ED visit is shown to be an issue among children receiving PHC and some determinants emerged as associated with ED visits by children in PHC.

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THE POTENTIAL FOR PHARMACISTS TO MANAGE CHILDREN ATTENDING EMERGENCY DEPARTMENTS

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.1 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.1-e2 ◽

Cited By ~ 1

Author(s):

David Terry ◽

Konstantinos Petridis ◽

Matt Aiello ◽

Anthony Sinclair ◽

Chi Huynh ◽

...

Keyword(s):

Emergency Department ◽

Community Pharmacist ◽

Emergency Departments ◽

Hospital Pharmacist ◽

General Medicine ◽

Clinical Group ◽

Medical Team ◽

Additional Training ◽

Paediatric Patients ◽

Impact Index

AimThere have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0–16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training.MethodA prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases—age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP—cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training—cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only—cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group.Results1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0–16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60.ConclusionPaediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.

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Stem cell separation in paediatric patients

Transfusion Science ◽

10.1016/s0955-3886(96)90098-3 ◽

1996 ◽

Vol 17 (4) ◽

pp. 607-610 ◽

Cited By ~ 2

Author(s):

J ZINGSEM

Keyword(s):

Stem Cell ◽

Cell Separation ◽

Paediatric Patients

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Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000001 ◽

2010 ◽

Vol 31 (1) ◽

pp. 1-6 ◽

Cited By ~ 62

Author(s):

Gregory Luke Larkin ◽

Annette L. Beautrais

Keyword(s):

Suicide Prevention ◽

Emergency Departments

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Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽

10.1027/0227-5910/a000499 ◽

2018 ◽

Vol 39 (5) ◽

pp. 318-325 ◽

Cited By ~ 8

Author(s):

Barbara Stanley ◽

Glenn W. Currier ◽

Megan Chesin ◽

Sadia Chaudhury ◽

Shari Jager-Hyman ◽

...

Keyword(s):

Emergency Departments ◽

Suicide Attempts ◽

The United States ◽

Administrative Claims ◽

Suicide Attempters ◽

Self Injury ◽

Axis I ◽

Ed Visits ◽

External Causes ◽

Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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