Is a Laboratory Evaluations Required in Every Case Admitting to the Pediatric Emergency Department with Epistaxis?

ABSTRACT Background: Epistaxis is a mostly self-limiting condition common among children and is rarely severe. In this study, it was aimed to evaluate the incidence, demographic characteristics, causes of bleeding and treatment methods of patients who applied to the Pediatric Emergency Department (PED) with epistaxis, and to determine in which cases a laboratory test should be used. Method: Admitted to Gazi University Faculty of Medicine, PED which provides trauma care and is a tertiary hospital, between January 1, 2019 and December 31, 2019, 452 patients aged 0-18 years who presented with epistaxis to any reason or secondary to systemic disease were analyzed retrospectively. Results: The annual incidence was found 1.23%. The median age was 63 months, 258 of the cases (57.1%) were male. It was found that the cases most frequently applied to the hospital in the autumn months (37.6%). Sixty of the patients (13.3%) had a chronic disease and 54 (11.9%) had a history of drug use. Bleeding time was less than 5 minutes in 75.2% and 84.4% of the bleeding was unilateral. Nasal bleeding is local in 73.4%; 4.7% of them developed due to systemic reasons. The most common cause of epistaxis; while they were trauma at the first 10 years of age, they were idiopathic causes after the age of 10 years. In 434 (96%) of the patients, epistaxis spontaneously stopped and there was no need for additional treatment. Conclusion: As a result of this study, it was concluded that laboratory tests should be performed in cases with chronic disease history, bilateral bleeding, active bleeding and nontraumatic epistaxis. The situation that causes epistaxis in the childhood age group should be determined with a good history and physical examination, laboratory tests should not be used in every patient. Key Words: pediatric emergency, epistaxis, laboratory examinations, complete blood count

Download Full-text

Treatment of suspected sepsis and septic shock in children with chronic disease seen in the pediatric emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.01.026 ◽

2021 ◽

Vol 44 ◽

pp. 56-61

Author(s):

Emily Hegamyer ◽

Nadine Smith ◽

Amy D. Thompson ◽

Andrew D. Depiero

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Chronic Disease ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Suspected Sepsis ◽

Sepsis And Septic Shock

Download Full-text

Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department

International Journal of Pediatrics ◽

10.1155/2018/4676758 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Mette Engan ◽

Asle Hirth ◽

Håvard Trønnes

Keyword(s):

Emergency Department ◽

Negative Predictive Value ◽

Resource Utilization ◽

Predictive Value ◽

Intraclass Correlation ◽

Tertiary Hospital ◽

Pediatric Emergency ◽

Interrater Agreement ◽

Pediatric Emergency Department ◽

Sensitivity Specificity

Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.

Download Full-text

THE EFFECTIVENESS OF LABORATORY TESTS FOR THE PREDICTION OF ACUTE BACTERIAL MENINGITIS IN THE PEDİATRİC EMERGENCY DEPARTMENT The Effectiveness of Laboratory Tests for the Prediction of Acute Bacterial Menengitis in the Pediatric Emergency Department

Turkish Journal of Pediatric Emergency and Intensive Care Medicine ◽

10.5505/cayb.2015.47955 ◽

2015 ◽

Vol 2 (1) ◽

pp. 19-24 ◽

Cited By ~ 1

Author(s):

Gamze Gökalp ◽

Alkan Bal ◽

Yüksel Bıcılıoğlu ◽

Fulya Kamit Can ◽

Neslihan Zengin ◽

...

Keyword(s):

Emergency Department ◽

Bacterial Meningitis ◽

Laboratory Tests ◽

Pediatric Emergency ◽

Acute Bacterial Meningitis ◽

Pediatric Emergency Department

Download Full-text

Decreased Incidence of Pediatric Intussusception during COVID-19

Children ◽

10.3390/children8111072 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1072

Author(s):

Jun Sung Park ◽

Young-Hoon Byun ◽

Seung Jun Choi ◽

Jong Seung Lee ◽

Jeong-Min Ryu ◽

...

Keyword(s):

Emergency Department ◽

Linear Regression ◽

Odds Ratio ◽

Tertiary Hospital ◽

Pediatric Emergency ◽

Communicable Diseases ◽

Pediatric Emergency Department ◽

Lower Base ◽

Log Linear ◽

Clinical Changes

Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.

Download Full-text

Undifferentiated Abdominal Pain in Children Presenting to the Pediatric Emergency Department

Clinical Pediatrics ◽

10.1177/0009922819867459 ◽

2019 ◽

Vol 58 (11-12) ◽

pp. 1212-1223

Author(s):

Brendan R. Harris ◽

Sri S. Chinta ◽

Ryan Colvin ◽

David Schnadower ◽

Phillip I. Tarr ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Abdominal Pain ◽

Laboratory Tests ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

C Reactive Protein ◽

Reactive Protein ◽

Laboratory Results ◽

Ed Visits

Although common, little is known about the characteristics and management of undifferentiated abdominal pain (UAP) in the pediatric emergency department (ED). This study was a 12-month retrospective study for “abdominal pain” ED visits. Patients without an identifiable diagnosis were categorized as “UAP,” while others with identified disease processes were categorized as “structural gastrointestinal diagnosis (SGID).” We included 2383 (72%) visits with 869 (36.5%) UAP visits and 1514 (63.5%) SGID visits. SGID patients had more laboratory tests (811 [53.6%] vs 422 [48.6%], P = .0186), and often had multiple tests performed (565 [69.7%] vs 264 [62.6%], P = .0116). Computed tomography and ultrasound scans were more common in SGID (computed tomography: 108 [7.1%] vs 27 [3.1%], P = .0004; ultrasound: 377 [24.9%] vs 172 [19.9%], P = .0044), and laboratory results (white blood cell count, hemoglobin, albumin, C-reactive protein) were abnormal at significantly higher rates. Analyses revealed the duration of pain as primary covariate in variance of pain etiology. Clinical features, such as duration of pain, may be augmented by laboratory tests to facilitate recognition of UAP in the ED.

Download Full-text

Pediatric emergency department; resource exhaustion and burden of work in a resource-constrained region.

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.6241806 ◽

2021 ◽

Vol 62 (4) ◽

pp. 110-116

Author(s):

Hasanein Habeeb Ghali ◽

Mustafa A. Al-Shafiei ◽

Hayder M. Al-Musawi

Keyword(s):

Emergency Department ◽

Complete Blood Count ◽

Hospital Setting ◽

Pediatric Emergency ◽

P Value ◽

Pediatric Emergency Department ◽

Cross Sectional ◽

Chronic Respiratory Diseases ◽

Resource Exhaustion ◽

Tract Infections

Background: emergency care is well known as the care delivered in a hospital setting to any patient with unexpected, sudden, threatening reversible condition. In countries where health care is not optimum, this type of care represents the weakest element of the health system. Aims of the study: to figure out the main causes behind the admission in Pediatric Emergency Department (PED) of Children Welfare Teaching Hospital (CWTH) and the urgency of visits. Patients and methods: a cross sectional study retrospective analysis that was carried out in the PED of CWTH in Medical City, Baghdad. Five hundred visits for patients below the age of 14 years between August and November 2017 were enrolled in this study and their data were analyzed. Perceived urgency of the current visit was assessed and analyzed. Results: the mean age for the patients was 3 years. Males represent 239 patients (47.8%). Of the whole group, 110 patients with a range of hours (22.0%). The most common complaint recorded was fever in 175 patients (21.0%). The most common comorbidities recorded were chronic respiratory diseases in 10 patients. Complete blood count was ordered for 460 patients (92.0%). Strikingly, blood culture was recorded in 5 patients only (1.0%). Reviewing the patients’ files has shown that 381 patients (76.2%) were prescribed antibiotics during stay in PED. The diagnosis of the patients visiting the PED was documented in 252 (50.4%) patients’ files only. Lower respiratory tract infections were the most frequently recorded diagnosis in 41 patients (8.2%). 266 patients (53.2%) were shown to be urgent visits, while 234 of them (46.8%) were non-urgent visits. Most of the patients who have comorbidities were labeled as urgent patients (89.4%), with a significant statistical difference (P value 0.001). Most of the patients who presented with a duration of complaint of within hours (89.1%) were stratified as urgent cases. Noteworthy, the majority of the patients who did not receive antibiotic therapy were stratified to be urgent (74.7%), the p value was 0.0001. Considering the disposition of the patients, majority of the patient who were discharged home (61.2%) were stratified as non-urgent, while (38.8%) were urgent. Conclusions: The study identifies the critical pitfalls of improper documentation of the data in the PED. It also delineates the resource exhaustion from the non-urgent visits. This may call for the need of structured training of physicians in the PED to improve efficiency, and reduce the cost and expenses of each patients through reducing the investigations and this will improve the standards of service. Triage system should be implemented in CWTH PED.

Download Full-text