Healthcare trajectory of children with rare bone disease attending pediatric emergency departments

Abstract Background Children with rare bone diseases (RBDs), whether medically complex or not, raise multiple issues in emergency situations. The healthcare burden of children with RBD in emergency structures remains unknown. The objective of this study was to describe the place of the pediatric emergency department (PED) in the healthcare of children with RBD. Methods We performed a retrospective single-center cohort study at a French university hospital. We included all children under the age of 18 years with RBD who visited the PED in 2017. By cross-checking data from the hospital clinical data warehouse, we were able to trace the healthcare trajectories of the patients. The main outcome of interest was the incidence (IR) of a second healthcare visit (HCV) within 30 days of the index visit to the PED. The secondary outcomes were the IR of planned and unplanned second HCVs and the proportion of patients classified as having chronic medically complex (CMC) disease at the PED visit. Results The 141 visits to the PED were followed by 84 s HCVs, giving an IR of 0.60 [95% CI: 0.48–0.74]. These second HCVs were planned in 60 cases (IR = 0.43 [95% CI: 0.33–0.55]) and unplanned in 24 (IR = 0.17 [95% CI: 0.11–0.25]). Patients with CMC diseases accounted for 59 index visits (42%) and 43 s HCVs (51%). Multivariate analysis including CMC status as an independent variable, with adjustment for age, yielded an incidence rate ratio (IRR) of second HCVs of 1.51 [95% CI: 0.98–2.32]. The IRR of planned second HCVs was 1.20 [95% CI: 0.76–1.90] and that of unplanned second HCVs was 2.81 [95% CI: 1.20–6.58]. Conclusion An index PED visit is often associated with further HCVs in patients with RBD. The IRR of unplanned second HCVs was high, highlighting the major burden of HCVs for patients with chronic and severe disease.

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A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

Clinical Pediatrics ◽

10.1177/00099228211006688 ◽

2021 ◽

Vol 60 (4-5) ◽

pp. 247-251

Author(s):

Ameer Hassoun ◽

Nessy Dahan ◽

Christopher Kelly

Keyword(s):

New York ◽

Case Reports ◽

Severe Disease ◽

Case Series ◽

Pediatric Emergency ◽

Rt Pcr ◽

Vulnerable Group ◽

Mild Disease ◽

Young Infants ◽

Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

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Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)—study protocol

BMJ Open ◽

10.1136/bmjopen-2020-041093 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041093

Author(s):

Todd Adam Florin ◽

Daniel Joseph Tancredi ◽

Lilliam Ambroggio ◽

Franz E Babl ◽

Stuart R Dalziel ◽

...

Keyword(s):

Emergency Department ◽

Prediction Model ◽

Severe Disease ◽

Pediatric Emergency ◽

Global Network ◽

Clinical Prediction ◽

Emergency Research ◽

Research Networks ◽

Clinical Prediction Model ◽

Severity Scores

IntroductionPneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysisThis study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and disseminationThis study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children’s Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.

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526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.720 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S330-S330

Author(s):

Jocelyn Y Ang ◽

Nirupama Kannikeswaran ◽

Basim Asmar

Keyword(s):

Mechanical Ventilation ◽

Severe Disease ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Pediatric Emergency ◽

Study Cohort ◽

Mild Disease ◽

Presenting Symptoms ◽

Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

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A New Radiographic Method for Estimating Tibial Malrotation

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.3.710.1 ◽

2020 ◽

Vol 7 (3) ◽

pp. 121-128

Author(s):

Hamidreza Yazdi ◽

◽

Mohammad Taher Ghaderi ◽

Alireza Yousof Gomrokchi ◽

Parham Pezeshk ◽

...

Keyword(s):

Lower Limb ◽

Evaluation Method ◽

Bone Fractures ◽

Distal Tibia ◽

Bone Diseases ◽

The Body ◽

University Hospital ◽

Radiographic Evaluation ◽

Minor Trauma ◽

Lower Limb Injury

Background: Diaphyseal tibial fractures are the most frequent bone fractures in the body and are usually treated with intramedullary nailing method. However, this approach is responsible for 41% of the rotational deviation. Objectives: This study aimed to provide a radiographic evaluation method to determine tibial malrotation in closed fixation of tibia bone fractures during or after the operation. Methods: This study was conducted in a university hospital from May 2015 to March 2016. All patients referring to the hospital with the complaints of minor trauma around the ankle and knee requiring radiographic evaluation of both joints were enrolled in the study. The inclusion criteria included being 20 and 50 years old; having normal axial, sagittal, and coronal lower limb alignment; lacking previous lower limb injury (such as fractures of the tibia or fibula), ankle or knee sprain; not having previous lower limb surgery, metabolic or congenital bone diseases, or malignancy. In all cases, a standard Anteroposterior (AP) radiograph of the knee was taken, and then, without changing the limb position or image setting, an AP radiograph of the ankle was obtained. The overlap between the distal tibia and fibula was measured in the PACS program environment. Results: Fifty cases were included in this study. The Mean±SD ages of males and females were 29.08±2.49 years and 31.46±2.04 years, respectively. The range of distal tibia-fibula overlap one centimeter above the tibiotalar joint line was 7.81 to 9.09 mm (confidence interval of 95%), and its percentage to the fibula shaft width at the same level was 49.43% to 54.35%. Conclusion: According to the results, distal tibia-fibula overlap when the knee is in the true AP position, regardless of the side and gender, is 7.81 to 9.09 mm or 49.43% to 54.35%.

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Familiares e representações do medo e sofrimento emocional da criança na emergência: reeducação colaborativa no cuidado

Archives of Health ◽

10.46919/archv2n6-005 ◽

2021 ◽

Vol 2 (6) ◽

pp. 1530-1549

Author(s):

Silvia Helena Oliveira Da Cunha ◽

Eliane Ramos Pereira ◽

Rose Mary Costa Rosa Andrade Silva ◽

Renata Carla Nencetti Pereira Rocha

Keyword(s):

Positive Reinforcement ◽

Emotional Health ◽

Participant Observation ◽

Social Representations ◽

Child Death ◽

Structured Interview ◽

Pediatric Emergency ◽

University Hospital ◽

The Family ◽

Culture Of Fear

Problema: Relações entre família e criança hospitalizada no contexto da emergência, reforçam frequentemente a cultura do medo por meio de condutas que a amedrontam demasiadamente, especialmente quando submetidas aos procedimentos dolorosos. Objetivos: analisar representações sociais da família acerca do sofrimento da criança na emergência; identificar a cultura do medo no contexto das representações da família e implicações; elaborar cartilha aos familiares como ferramenta facilitadora na minimização do estresse psicológico da criança. Método: Estudo descritivo, abordagem qualitativa, pautada na Teoria das Representações Sociais, utilizou-se técnicas de evocação livre, entrevista semiestruturada e observação participante. Os dados foram submetidos à análise de Bardin e classificados em cinco categorias: 1) profissionais de saúde; 2) objetos estranhos; 3) evento indesejável; 4) bactéria e infecção hospitalares e 5) medo da morte da criança. O estudo realizado na emergência pediátrica de um hospital universitário no município de Niterói/RJ e cujos sujeitos foram os familiares que acompanharam as crianças hospitalizadas. Conclusão: Percebe-se no cotidiano da emergência, que crianças sofrem dor emocional, antes da dor física, visto que medo excessivo da criança é culturalmente incentivado e aceito pelas famílias. Desconstruí-lo com educação e reforço positivo é eficaz ferramenta estratégica de promoção da saúde emocional ao binômio criança-família. Problem: Relationships between hospitalized family and child in the emergency context often reinforce the culture of fear through behaviors that frighten her too much, especially when subjected to painful procedures. Objectives: to analyze social representations of the family about the suffering of the child in the emergency; Identify the culture of fear in the context of family representations and implications; To elaborate a booklet for the family as a facilitating tool in minimizing the psychological stress of the child. Method: Descriptive study, qualitative approach, based on Social Representations Theory, we used free evocation techniques, semi-structured interview and participant observation. The data were submitted to the analysis of Bardin and classified into five categories: 1) health professionals; 2) foreign objects; 3) undesirable event; 4) hospital bacterium and infection; and 5) fear of child death. The study carried out in the pediatric emergency of a university hospital in the city of Niterói / RJ and whose subjects were the relatives who accompanied the hospitalized children. Conclusion: It is noticed in the daily emergency that children suffer emotional pain, before physical pain, since excessive fear of the child is culturally encouraged and accepted by families. Deconstructing it with education and positive reinforcement is an effective strategic tool for promoting emotional health to the binomial child-family.

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Proceedings of the 2019 Santa Fe Bone Symposium: New Concepts in the Care of Osteoporosis and Rare Bone Diseases

Journal of Clinical Densitometry ◽

10.1016/j.jocd.2019.09.006 ◽

2020 ◽

Vol 23 (1) ◽

pp. 1-20 ◽

Cited By ~ 1

Author(s):

E. Michael Lewiecki ◽

John P. Bilezikian ◽

Risa Kagan ◽

Deborah Krakow ◽

Michael R. McClung ◽

...

Keyword(s):

Bone Diseases ◽

Santa Fe ◽

New Concepts ◽

Rare Bone Diseases

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Providing high-quality care remotely to patients with rare bone diseases during COVID-19 pandemic

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01513-6 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

E. Brizola ◽

G. Adami ◽

G. I. Baroncelli ◽

M. F. Bedeschi ◽

P. Berardi ◽

...

Keyword(s):

Quality Care ◽

Bone Diseases ◽

High Quality ◽

High Quality Care ◽

Rare Bone Diseases

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Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

Journal of Primary Care & Community Health ◽

10.1177/2150132720926276 ◽

2020 ◽

Vol 11 ◽

pp. 215013272092627

Author(s):

Julia Ellbrant ◽

Jonas Åkeson ◽

Helena Sletten ◽

Jenny Eckner ◽

Pia Karlsland Åkeson

Keyword(s):

Primary Care ◽

Emergency Department ◽

Patient Characteristics ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

University Hospital ◽

Pediatric Emergency Department ◽

Hospital Data ◽

Cross Sectional ◽

Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

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Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

Dentistry Journal ◽

10.3390/dj7040116 ◽

2019 ◽

Vol 7 (4) ◽

pp. 116

Author(s):

Noémie Gulion ◽

Jean-Noel Vergnes

Keyword(s):

Dental Care ◽

Care Pathway ◽

Waiting Times ◽

Oral Care ◽

Structured Interview ◽

University Hospital ◽

Research Approach ◽

Emergency Situations ◽

Access To Dental Care ◽

Data Saturation

Background: We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. Methods: We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. Results: When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants; (2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks—apprehension about long waiting times was mentioned by several participants. Conclusions: Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.

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Infant Case of Co-infection with SARS-CoV-2 and Citrobacter koseri Urinary Infection

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa032 ◽

2020 ◽

Author(s):

Hyppolite K Tchidjou ◽

Bernard Romeo

Keyword(s):

Mortality Rate ◽

Infection Control ◽

Disease Control ◽

Urinary Infection ◽

Severe Disease ◽

Control Measures ◽

University Hospital ◽

Infection Control Measures ◽

Control And Prevention ◽

Infant Case

Abstract Since 2019 coronavirus disease (COVID-19) is highly contagious with a high mortality rate. France has taken strict infection control measures. According to the report by the Center for Disease Control and Prevention, children are less affected with COVID-19 and seem to have less severe disease than adults. We reported the first confirmed infant case of co-infection with SARS-CoV-2 and Citrobacter koseri urinary infection in 6-week-old child admitted on 25 March 2020 with mild symptoms in the Pediatric COVID Unit of Amiens University Hospital, France.

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