scholarly journals Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Leopold Simma ◽  
Martin Stocker ◽  
Markus Lehner ◽  
Lea Wehrli ◽  
Franziska Righini-Grunder
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Inclusion Criteria ◽  
Cns Disorders ◽  
High Acuity ◽  
Scale Category

Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission.Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018–2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital.Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%).Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.

The Burden of Burnout Syndrome in Pediatric Intensive Care Unit and Pediatric Emergency Department

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mutlu Uysal Yazici ◽  
Ozlem Teksam ◽  
Hasan Agin ◽  
Nilgun Erkek ◽  
Ali Ertug Arslankoylu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Emergency ◽  
Burnout Syndrome ◽  
Pediatric Emergency Department

scholarly journals Community acquired pneumonia (CAP): Epidemiology, clinical presentation, management and outcomes in infants and children presenting to Al Wakra Pediatric Emergency Department (PED)

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ibtihal S Abdelgadir ◽  
Haider Almawashi ◽  
Fawzia M Elgharbawy ◽  
Abdo M Alghazali ◽  
Kryzl D Ponce ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Community Acquired Pneumonia ◽  
Infants And Children ◽  
Pediatric Emergency Department ◽  
Reactive Protein ◽  
Amoxicillin Clavulanic Acid ◽  
In Infants And Children

Background: Community acquired pneumonia (CAP) is defined clinically as the presence of signs and symptoms of pneumonia in a previously healthy child due to an infection that has been acquired outside the hospital. There is no previous data available from children in Qatar on CAP.Objectives: To evaluate the incidence, clinical features, management, outcomes and, complications in infants and children presenting to Al Wakra Hospital, Qatar with CAP. Methods: This is a prospective, observational, non-interventional study that assessed all children aged 3 months to 14 years, during a period of 12 months, from November 2017 to November 2018. Results: The incidence of CAP was found to be 2.8 per 1000 of all patients presenting to Al Wakra Pediatric Emergency Department Qatar (328 of 116,761patients). The majority of cases were children 1-5 years (58.2%). Fifty-one percent and 61.3% of children admitted to inpatient wards had dyspnoea and tachypnea respectively. This is to be compared to 88.5% and 96.2% of patients respectively admitted to the Pediatric Intensive Care Unit (PICU) with dyspnoea and with tachypnea. C-reactive protein (CRP) more than 50 mg/L was noted in 48.2% of patients admitted to inpatient wards and 26.7% of patients admitted to PICU. Oral amoxicillin was prescribed for 1.5% of patients, amoxicillin/clavulanic acid for 18% of patients, a further 18% had cefuroxime, and 29% had clarithromycin. Intravenous (IV) cefuroxime was the most used IV medication (29.6% of all patients). Nearly 50% of patients were admitted to inpatient wards, with 7.9% transferred to PICU, and only 39.3% discharged home without admission. Conclusion: Community acquired pneumonia represents 0.28% of all studied patients. More than 60% of the patients with CAP were admitted either to inpatient wards or to PICU.

scholarly journals Pharmacologic Management of Agitation and Aggression in a Pediatric Emergency Department – A Retrospective Cohort Study

2018 ◽  
Vol 23 (6) ◽  
pp. 455-459 ◽  
Author(s):  
Jennifer G. Kendrick ◽  
Ran D. Goldman ◽  
Roxane R. Carr
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Single Agent ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Inclusion Criteria ◽  
Medication Utilization ◽  
Pharmacologic Management ◽  
Acute Agitation ◽  
To Receive

BACKGROUND Benzodiazepine and antipsychotic use for acute management of agitation and aggression in the pediatric emergency department (ED) setting has not been well described. OBJECTIVES To describe medication utilization in the management of agitation and aggression in a pediatric ED and to assess the safety of their use. METHODS This was a retrospective observational study. Patients less than 20 years of age who presented to our pediatric ED and had agitation or aggression as part of their chief complaint were included if they received at least 1 dose of benzodiazepine or antipsychotic. Outcomes included frequency of benzodiazepine and antipsychotic use, dosing of medications, and reported adverse events. RESULTS During the 5-year study period, there were 128 visits of 120 patients who met the inclusion criteria. Lorazepam was most commonly given (70%), followed by chlorpromazine (20%). Most patients (82%) required a single dose of medication. Intoxication was associated with needing more than 1 dose of medication. Patients with autism or Asperger syndrome were more likely to receive an antipsychotic medication compared to not having these conditions (75% vs. 28%, respectively). Adverse events were documented in 6 visits: oxygen desaturation (n = 1), dizziness and nausea (n = 2), dizziness (n = 1), and paradoxical excitation (n = 2). The Naranjo Score indicated a probable adverse drug reaction for the cases of paradoxical excitation. CONCLUSIONS Benzodiazepine and antipsychotic drug therapy for acute agitation and aggression in children appears to be safe and well tolerated when used as a single agent and at the recommended doses in this setting.

Epidemiology of Pediatric Critically-ill Patients Presenting to the Pediatric Emergency Department

2013 ◽  
Vol 225 (01) ◽  
pp. 18-23 ◽  
Author(s):  
W.-C. Yang ◽  
Y.-R. Lin ◽  
L.-L. Zhao ◽  
Y.-K. Wu ◽  
Y.-J. Chang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

CJEM ◽  
2011 ◽  
Vol 13 (02) ◽  
pp. 90-95 ◽  
Author(s):  
F. Jonathan Guilfoyle ◽  
Ruth Milner ◽  
Niranjan Kissoon
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Rare Event ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Pediatric Emergency ◽  
Working Relationships ◽  
Pediatric Emergency Department ◽  
Successful Resuscitation ◽  
Central Lines

ABSTRACT Objective: To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). Methods and Material: This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. Results: There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n = 115, 35%), trauma (n = 50, 15%), sepsis (n = 36, 11%), seizures (n = 37, 11%), and cardiac disease (n = 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Conclusion: Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.

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