Nocturnal emergency department visits, duration of symptoms and risk of hospitalisation among adults with asthma exacerbations: a multicentre observational study

Abstract Objective: Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months. Results: A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child’s asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child’s future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child’s asthma. Conclusion: Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations.

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Paediatric acute lymphadenitis: Emergency department management and clinical course

Paediatrics & Child Health ◽

10.1093/pch/pxz125 ◽

2019 ◽

Vol 25 (8) ◽

pp. 534-542

Author(s):

Michelle Long ◽

Deepti N Reddy ◽

Salwa Akiki ◽

Nicholas J Barrowman ◽

Roger Zemek

Keyword(s):

Emergency Department ◽

Antibiotic Use ◽

Emergency Department Visits ◽

Surgical Drainage ◽

Cervical Lymphadenitis ◽

Intravenous Antibiotic ◽

Duration Of Symptoms ◽

Factors Associated ◽

Emergency Department Management ◽

Return Visits

Abstract Objectives To describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications. Methods Health record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009–2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage. Results Of 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36). Conclusions The vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.

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Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study

BMC Pharmacology and Toxicology ◽

10.1186/s40360-019-0297-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Ivan Lo Giudice ◽

Eleonora Mocciaro ◽

Claudia Giardina ◽

Maria Antonietta Barbieri ◽

Giuseppe Cicala ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Adverse Drug Events ◽

Emergency Department Visits

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Medication-Related Emergency Department Visits in Pediatrics: a Prospective Observational Study

PEDIATRICS ◽

10.1542/peds.2014-1827d ◽

2015 ◽

Vol 135 (3) ◽

pp. X4-X4

Keyword(s):

Emergency Department ◽

Observational Study ◽

Prospective Observational Study ◽

Emergency Department Visits

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78 COVID-19 Pandemic Did Not Exacerbate Racial Disparity in Incidence of Emergency Department Visits For Asthma Exacerbations

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2021.07.080 ◽

2021 ◽

Vol 78 (2) ◽

pp. S37

Author(s):

R. Hossain ◽

J. Ruff ◽

D. Kaelber ◽

Y. Tarabichi

Keyword(s):

Emergency Department ◽

Racial Disparity ◽

Emergency Department Visits ◽

Asthma Exacerbations

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Emergency department visits for children with asthma exacerbations living in locations with different climates

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2004.12.693 ◽

2005 ◽

Vol 115 (2) ◽

pp. S170

Author(s):

A.P. McLaughlin ◽

M.A. Brown ◽

D.G. Hillman ◽

D. Brice ◽

P.W. Heymann

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Asthma Exacerbations ◽

Children With Asthma ◽

Different Climates

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Discharge from the Emergency Department and Early Hospital Revaluation in Patients with COVID-19 Pneumonia: an Observational Study

10.21203/rs.3.rs-289317/v1 ◽

2021 ◽

Author(s):

Massimo Mattioli ◽

Devis Benfaremo ◽

Francesca Fulgenzi ◽

Silvia Gennarini ◽

Luciano Mucci ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Control Group ◽

High Resolution Computed Tomography ◽

Hypoxemic Respiratory Failure ◽

Historical Cohort ◽

Duration Of Symptoms ◽

Risk Of Progression ◽

The Mean

Abstract Background Health National Systems world-wide are facing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We purpose an outpatient management for patients affected by SARS-CoV-2 related pneumonia at risk of progression, after discharge from Emergency Department (ED).Methods This was a single-center prospective observational study. We enrolled patients with confirmed SARS-CoV-2 pneumonia, without hypoxemic respiratory failure, and at least one of the following: age ≥ 65 or presence of one or more comorbidities or pneumonia involvement > 25% on high resolution computed tomography (HRCT). The ambulatorial visit was performed after at least 48 hours, then patients could be discharged, admitted for hospitalization, or deferred for a further visit. As a control, we evaluated a historical cohort of patients hospitalized with comparable clinical and radiological features.Results A total of 84 patients were enrolled (51 M, mean age 62.8 y). Two-thirds of patients had at least one comorbidity and 41.6% had a lung involvement > 25% at HRCT; the mean duration of symptoms was 8 ± 3 days and the mean PaO2/FiO2 ratio 357.5 ± 38.6. At the end of the follow-up period, 69 patients had been discharged and 15 hospitalized (mean stay 6 days). Older age and higher NEWS2 were significant predictors of hospitalization at the first follow-up visit. One hospitalized patient died of septic shock. In the control group, the mean hospital stay was 8 days.Conclusions Adopting a “discharge and early revaluation” strategy appear to be safe and feasible. This approach may help to optimize hospital resources during the SARS-CoV-2 pandemic.

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