Epidemiology of burns and scalds in children presenting to the emergency department of a regional burns unit: a 7-year retrospective study

Abstract Background Variation in the incidence and mechanism of thermal injury has been reported in different age groups in children. The aim of this study was to report the incidence, mechanisms, and environmental factors of all burns presentations to the emergency department (ED) of a regional burns centre over a 7-year period. Methods A retrospective, chart review study of all burns presentations to the ED of a regional burns centre in South Wales was conducted. All children recorded as having sustained a burn or scald, aged less than 16 years were included in the analysis. Subjects’ demographics were analysed using descriptive statistics, and comparisons were made between patients aged less than 5 and patients aged 5–16 using chi-square test and Mann–Whitney U test. Results A total of 1387 cases were included in the final analysis. Scalds were the most common thermal injury with 569 (41.0 %) reported, followed by contact burns in 563 (40.6 %) patients. The patients requiring hospitalisation were significantly younger (2 vs 3 years; p < 0.001) and had a higher rate of non-accidental injury (10 vs 4; p < 0.001). The most commonly injured site in both age groups was a hand or digit. Conclusions Scalds and contact burns were the most commonly reported thermal injury in children aged less than 16. Common mechanisms were hot beverages, hobs and hair straighteners, highlighting further burn prevention strategies are needed and good-quality prospective studies that investigate the effectiveness of such strategies.

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Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia

Pharmacy ◽

10.3390/pharmacy8040189 ◽

2020 ◽

Vol 8 (4) ◽

pp. 189

Author(s):

Mansour Tobaiqy ◽

Bandar A. Asiri ◽

Ahmed H. Sholan ◽

Yahya A. Alzahrani ◽

Ayed A. Alkatheeri ◽

...

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Age Groups ◽

Retrospective Chart Review ◽

Evidence Base ◽

Acute Poisoning ◽

Chi Square ◽

Jeddah City ◽

Policy And Strategy ◽

Poisoning In Children

Background: Acute poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: This study aimed to evaluate the frequency and management of acute poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0–16 years of age) from October-21-2016 to March-03-2020 who were attending the emergency department. Data were analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning in children who attended the emergency department at East Jeddah Hospital; males (n = 38, 55.1%). Most children were aged 5 years or younger (n = 41, 59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (n = 5) of patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (chi-square = 28.5057, p = 0.0001). Most incidences occurred at home (n = 64, 92.8%). Medicines were the most common cause of poisoning (n = 53, 76.8%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8%). The most common route of poisoning was oral ingestion (81.2%). One mortality case was documented. Conclusion: Although not common, accidental and deliberate acute poisoning in children does occur. More can be done to educate parents on safe storage of medicines, household cleaning and other products associated with acute poisoning in children. Likewise, children can be taught more about the risks of poisoning from an early age. As importantly, clinicians need to include more detailed notes in the electronic medical records (EMR) or the system needs to be improved to encourage completeness to more accurately inform the research evidence-base for future service design, health policy and strategy.

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Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.3p.7 ◽

2019 ◽

Vol 7 (3) ◽

pp. 7

Author(s):

Samad Shams-Vahdati ◽

Alireza Ala ◽

Eliar Sadeghi-Hokmabad ◽

Neda Parnianfard ◽

Maedeh Gheybi ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Statistical Significance ◽

Retrospective Chart Review ◽

Chi Square ◽

Prevention Therapy ◽

Significant Difference ◽

Chi Square Test ◽

Academic Teaching Hospital ◽

The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

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Trends and repetition of non-fatal suicidal behaviour: analyses of the Gold Coast University Hospital’s Emergency Department

Australasian Psychiatry ◽

10.1177/1039856217749059 ◽

2018 ◽

Vol 26 (2) ◽

pp. 170-175 ◽

Cited By ~ 6

Author(s):

Kairi Kõlves ◽

David Crompton ◽

Kathryn Turner ◽

Nicolas JC Stapelberg ◽

Ashar Khan ◽

...

Keyword(s):

Emergency Department ◽

Suicidal Behaviour ◽

Proportional Hazards ◽

Cox Regression ◽

Age Groups ◽

Cox Proportional Hazards ◽

Gold Coast ◽

First Year ◽

Chi Square ◽

Chi Square Test

Objective The aim of the current paper is to analyse time trends of non-fatal suicidal behaviour (NFSB) and its repetition at the Gold Coast in 2005–2015. Methods Data on presentations for NFSB were obtained from the Emergency Department (ED) Information System. Potential cases were identified through keyword searches, which were further scrutinised and coded. Annual person-based age-standardised rates for NFSB were calculated. Chi-square test, Poisson regression and Cox proportional hazards regression were used. Results: There was a significant increase in the age-standardised rates of NFSB for males (incidence Rate Ratio = 1.05; 95% confidence interval (CI): 1.04–1.07) and females (iRR = 1.06; 95% CI: 1.04–1.07). Age-specific rates showed significant increases for all age groups, except 25–34 and 55+ for females. Different types of poisoning were the predominant method of NFSB (poisoning only – 61.7% of episodes), followed by cutting (23%). Within the first year after the index episode, 13.4% of subjects repeated NFSB. Multivariate Cox regression model showed that sex, age and method predicted repetition. Conclusion: The increasing trends of NFSB and relatively high repetition rates emphasise the need for preventative actions. Monitoring of NFSB at the ED level should be further extended in Australia.

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Abstract TP249: Collaborative In-Person Bedside Handover Improves Emergency Department Nurses’ Confidence in and Compliance With Documentation of Frequent Post Alteplase Neurological Assessments

Stroke ◽

10.1161/str.51.suppl_1.tp249 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kailey L Cox ◽

Jessica Lobell ◽

Xavier Champagne ◽

Alyx Lesko ◽

Leslie Corless ◽

...

Keyword(s):

Emergency Department ◽

Phase 1 ◽

Vital Signs ◽

Retrospective Chart Review ◽

Chi Square ◽

Emergency Department Nurses ◽

New Strategy ◽

Improve Compliance ◽

Chi Square Test ◽

Strongly Agree

Introduction: Stroke centers are often cited for poor compliance with post alteplase (tPA) neurological assessment documentation (SNAP DOC). Emergency department nurses (ED RNs) have less exposure to patients receiving tPA than neurocritical care nurses (NCCU RNs) and are less compliant with SNAP. In this project we sought to improve compliance of SNAP DOC in the ED. Methods: Data included retrospective chart review of SNAP DOC compliance for patients in ED treated with tPA age 18 and over from 03/2018 to 07/2019. In phase 1, ED RNs were trained in-person on SNAP three separate times between 02/2018 and 09/2018 (PRE). After seeing no improvement with SNAP in ED after the in-person education interventions, ED and NCCU collaborated to form a new strategy. In phase 2, beginning 12/14/2018 NCCU RNs retrieved their tPA patients from ED, performed a bedside SNAP and coached ED RNs on any missing SNAP DOC (POST). ED SNAP DOC were evaluated by finding the total number completed among the total possible opportunities combined across the four components of SNAP and vital signs. Three Likert scale questions were administered to assess ED RN confidence in SNAP practices for both PRE and POST timeframe with answers from 1 (strongly disagree) to 5 (strongly agree). PRE and POST responses were then dichotomized into agree (4-5) or disagree (1-3) and compared using Pearson’s chi square test. Descriptive analyses were performed to assess SNAP DOC compliance for the PRE and POST periods. Results: There were 111 charts audited for compliance that met inclusion criteria with 56 in the PRE and 55 in the POST. ED RNs were more compliant with SNAP in the POST (77.3%) compared to the PRE (65.6%). Confidence surveys were completed by 52 ED RNs in PRE and 72 RNs in POST. RNs were more confident in, “I understand the rationale behind each component of [SNAP]”, in the POST vs PRE timeframe (87.5% vs 68.6%, p=.010). Conclusion: ED RNs remained confident in their use of SNAP throughout the project despite compliance scores. However, in the POST period, ED RNs reported improvement in their understanding of SNAP. In-person handover process improves SNAP DOC compliance in ED more than in-person training.

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Frequency and Management of Drug and Chemical Poisoning among Children Attending an Emergency Department in a Single Hospital in Saudi Arabia

10.1101/2020.09.08.20190868 ◽

2020 ◽

Author(s):

Mansour Tobaiqy ◽

Bandar A Asiri ◽

Ahmed H Sholan ◽

Yahya A Alzahrani ◽

Ayed A Alkatheeri ◽

...

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Emergency Room ◽

Age Groups ◽

Retrospective Chart Review ◽

Acute Poisoning ◽

Chi Square ◽

Common Cause ◽

Jeddah City ◽

Poisoning In Children

Background: Unintentional poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: The study aimed to evaluate the frequency and management of poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0-16 years of age) from October-21-2016 to March-03-2020 who were admitted to the emergency department of East Jeddah Hospital, Jeddah city, Saudi Arabia. Data was analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning were admitted to the emergency room at East Jeddah Hospital; males were 55.1 %. Most children were under 5 years of age (59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (5) patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (Chi-square=28.5057, p=0.0001). Most incidences occurred at home (92.8%). Medicines were the most common cause of poisoning (73.9%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8 %). The most common route of poisoning was oral administration (81.2%). One mortality case was documented due to poisoning. Conclusion: A total of 69 incidences of acute poisoning in children occurred in a single hospital over 3 years. Most incidents were Unintentional and occurred in children younger than 5 years of age. Medicines were the most common cause of poisoning. Analgesics such as paracetamol were the most common documented medicine associated with poisoning.

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The Influence of Age and Gender on Mandibular Indices among the Libyan Population

Journal of Oral & Dental Health ◽

10.33140/jodh.03.02.2 ◽

2019 ◽

Vol 3 (2) ◽

Keyword(s):

Negative Correlation ◽

Bone Mineralization ◽

Age Groups ◽

T Test ◽

Chi Square ◽

Age And Gender ◽

Significant Difference ◽

Chi Square Test ◽

And Gender ◽

Libyan Population

Radiographic Mandibular Indices serve as easy and relatively cheap tools for evaluating bone mineralization. Objectives: To examine the effect of age and gender on three mandibular indices: the panoramic mandibular index (PMI), the mandibular ratio (MR) and the mandibular cortical index (MCI), among Libyan population. Methods: The three indices were measured on 317 digital (OPGs) of adult humans (155 males, 162 females). The sample was divided into six age groups (from 18-25 years through 56-65 years). The measurements were analyzed for interactions with age and sex, using SPSS (Statistical Package for Social Studies) software version no. 22. The tests employed were two way ANOVA, the unpaired T-test and chi-square test. Results: The mean PMI fluctuated between 0.37 s.d. 0.012 and 0.38 s.d. 0.012. among the sixth age groups. One-way ANOVA statistical test revealed no significant of age on PMI. On the other hand gender variation has effect on PMI, since independent sample t-test disclosed that the difference between the male and female PMI means statistically significant. ANOVA test showed that the means of MR among age groups showed a negative correlation i.e. MR mean declined from 3.01 in 18-25 age groups to 2.7 in 55-65 age groups. In contrary, the gender showed no effect on MR according two sample t-test at p> 0.05. In regards with MCI, statistical analysis showed that it affected by age that is C1 was decreasing by age while C2 and C3 were increased by age. Using chi square test the result indicated that there is a significant difference among the different age group and the two genders in MCI readings. Conclusion: PMI was influenced significantly by age but minimally by the gender. MR is not affected by gender but has a negative correlation with age. MCI is affected by both age and gender

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Changes in Six-Month Prevalence of Circulatory System Diseases among People Aged 20 Years and Older between 2013 and 2018 in Hunan, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052599 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2599

Author(s):

Zhenzhen Rao ◽

Junjie Hua ◽

Ruotong Li ◽

Yanhong Fu ◽

Jie Li ◽

...

Keyword(s):

Age Groups ◽

Circulatory System ◽

Population Based ◽

Hunan Province ◽

Rural Residents ◽

Chi Square ◽

Circulatory System Diseases ◽

Chi Square Test ◽

Urban Rural ◽

Socio Demographic Factors

Recent changes in population-based prevalence for circulatory system diseases (CSDs) remain unreported either nationally or locally for China. Data were from the two-round health service household interview survey of Hunan Province, China, in 2013 and 2018. A Rao–Scott chi-square test was performed to examine prevalence differences across socio-demographic variables. The overall age-standardized prevalence of CSDs increased substantially between 2013 and 2018 for inhabitants aged 20 years and older (14.25% vs. 21.25%; adjusted odds ratio (OR) = 1.59, 95% CI: 1.24–2.04). Hypertensive disease was the most prevalent type of CSD, accounting for 87.24% and 83.83% of all CSDs in 2013 and in 2018, respectively. After controlling for other socio-demographic factors, the prevalence of CSDs was significantly higher in 2018 (adjusted OR = 1.40), urban residents (adjusted OR = 1.43), females (adjusted OR = 1.12) and older age groups (adjusted OR = 5.36 for 50–59 years, 9.51 for 60–69 years, 15.19 for 70–79 years, and 12.90 for 80 years and older) than in 2013, rural residents, males and the youngest age group (20–49 years). The recent increase in the overall age-standardized CSD prevalence and the large prevalence disparities across urban/rural residents, sex and age groups merit the attention of policymakers and researchers. Further prevention efforts are needed to curb the increasing tendency and to reduce the prevalence of disparities across socio-demographic groups.

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Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽

10.1161/circ.142.suppl_3.14721 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ghufran adnan ◽

Osman Faheem ◽

Maria Khan ◽

Pirbhat Shams ◽

Jamshed Ali

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Reduction Rate ◽

Care Hospital ◽

Chi Square ◽

Coronary Syndrome ◽

Significant Difference ◽

Drastic Increase ◽

Chi Square Test ◽

The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

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The influence of varying maxillary central incisor vertical dimension on perceived smile aesthetics

Journal of Orthodontics ◽

10.1177/1465312519839713 ◽

2019 ◽

Vol 46 (2) ◽

pp. 137-142

Author(s):

Elis Janaina Lira dos Santos ◽

Alana Moura Xavier Dantas ◽

Raíssa Marçal Vilela ◽

Karina Jerônimo Rodrigues Santiago de Lima ◽

Rejane Targino Soares Beltrão

Keyword(s):

Age Groups ◽

Educational Background ◽

Cross Sectional Study ◽

Central Incisor ◽

Chi Square ◽

Cross Sectional ◽

Exact Test ◽

Maxillary Central Incisor ◽

Significant Difference ◽

Chi Square Test

Objective: To evaluate patient perception of the smile focused on analysis of the upper incisors. Design: Cross-sectional study. Setting: Department of Clinical and Social Dentistry at Federal University of Paraíba, João Pessoa, Brazil. Participants: The sample consisted of 135 individuals (73 women and 62 men). Methods: Images with different characteristics associated with the incisal edges were shown at random and analysed using a Likert scale. Data were analysed using the Chi-square test or Fisher’s exact test with a statistically significant difference ( P < 0.05). Results: Smile I (difference of 1.5 mm in relation to the central incisor and lateral) was considered the most aesthetic, while Smile III (no difference in height between the central and lateral incisors) was the least aesthetic. A significant difference was found between perception of smile II (difference of 1 mm in relation to the central incisor and lateral) and age groups ( P < 0.005), with 31% (n = 13) of individuals aged 45–64 years considering smile II as not pleasant, 4.4% (n = 2) aged 15–24 years and 8.3% (n=4) aged 25–44 years and 4.4% (n = 2) aged 15–24 years considering the same. A significant difference was also found in relation to educational background of the assessor and smile perception, with smile III ( P = 0.0441) and smile IV ( P = 0.0053) considered the most aesthetic ( P = 0.0116). Conclusion: The smile considered most attractive among the sample was that with 1.5 mm steepness between the central and lateral incisors, while a flat smile arc was considered least attractive.

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Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.6.460 ◽

2018 ◽

Vol 23 (6) ◽

pp. 460-465

Author(s):

Jordan Anderson ◽

Sevilay Dalabih ◽

Esma Birisi ◽

Abdallah Dalabih

Keyword(s):

Chart Review ◽

Chloral Hydrate ◽

Pediatric Patients ◽

Age Groups ◽

Retrospective Chart Review ◽

Final Analysis ◽

Age Group ◽

Imaging Studies ◽

Airway Complications ◽

Adequate Sedation

OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.

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