paediatric emergency department
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BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056476
Author(s):  
Antoine Tran ◽  
Anne-Laure Hérissé ◽  
Marion Isoardo ◽  
Petri Valo ◽  
Anne-Marie Maillotte ◽  
...  

ObjectiveTo evaluate compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.DesignProspective, single centre.SettingFourth biggest PED in France in terms of attendance (CHU-Lenval).Patients280 patients of whom 249 were included in the statistical analysis.Main outcome measuresThe primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviewsResults77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS’s postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS’s postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).ConclusionPostbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.Trial registration numberThe study bears the clinical trial number NCT02863627.


2021 ◽  
pp. 1-13
Author(s):  
Barbara De Vito ◽  
Emanuele Castagno ◽  
Emanuela Garrone ◽  
Irene Tardivo ◽  
Alessio Conti ◽  
...  

2021 ◽  
pp. 1-7
Author(s):  
Eser Doğan ◽  
Caner Turan ◽  
Ali Yurtseven ◽  
Benay Turan ◽  
Eylem Ulaş Saz

Abstract Introduction: Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1–76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1–76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. Methods: All children aged 0–18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients’ demographic characteristics, presenting complaints, clinical findings, and N-terminal (1–76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. Results: This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1–76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1–76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. Conclusion: Using scoring systems in combination with N-terminal (1–76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e047139
Author(s):  
Rachel Isba ◽  
Rhiannon Edge

ObjectiveThe objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED).DesignA feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months.SettingThis pilot took place in a single PED in Greater Manchester, England.ParticipantsParticipants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019.InterventionsThe intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance.Primary and secondary outcome measuresThe primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study.ResultsThirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate.ConclusionsIt is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.


2021 ◽  
Vol 5 (1) ◽  
pp. e001267
Author(s):  
Manon Jaboyedoff ◽  
Carl Starvaggi ◽  
Joan-Carles Suris ◽  
Claudia E Kuehni ◽  
Mario Gehri ◽  
...  

BackgroundLow-acuity paediatric emergency department (PED) visits are common in high-income countries and are an increasing burden for the healthcare system and quality of care. Little is known about low-acuity PED visits in Switzerland. This study shows frequency and characteristics of such visits in two large PEDs in German-speaking and French-speaking regions of Switzerland.MethodsWe conducted a retrospective observational study in the PED of two Swiss tertiary care hospitals, Bern and Lausanne. We extracted standardised administrative and medical data from the clinic information system for all PED visits of children aged 0–17 years from January to December 2018. We defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits.ResultsWe analysed 53 089 PED visits. The proportion of low-acuity visits was 54% (95% CI 53% to 54%, 28 556 visits). Low-acuity visits were associated with age younger than 5 years (adjusted OR, aOR 1.87, 95% CI 1.81 to 1.94), living within a 5 km radius of PED (aOR 1.27, 95% CI 1.22 to 1.32), and after hour presentations (weekends: aOR 1.14, 95% CI 1.10 to 1.18, nights: aOR 1.10, 95% CI 1.23 to 1.36).ConclusionLow-acuity visits are frequent in our PEDs and associated with younger age and convenience factors (proximity of residency and after hour presentation), pointing to a high demand for paediatric urgent care services in Switzerland not currently covered by the primary healthcare system.


BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054234
Author(s):  
Reza Rasti ◽  
Johanna Brännström ◽  
Andreas Mårtensson ◽  
Ingela Zenk ◽  
Jesper Gantelius ◽  
...  

ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative focus group discussions study. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.


Author(s):  
Eirini Kostopoulou ◽  
Despoina Gkentzi ◽  
Marios Papasotiriou ◽  
Sotirios Fouzas ◽  
Anastasia Tagalaki ◽  
...  

2021 ◽  
Author(s):  
Tommaso Bellini ◽  
Gioacchino Andrea Rotulo ◽  
Samuele Caruggi ◽  
Sabina Carta ◽  
Irene Bonato ◽  
...  

Author(s):  
VJM Lim ◽  
V James ◽  
YJE Yeo ◽  
YM Low ◽  
YR Chew ◽  
...  

Introduction: This study aimed to characterise neonatal paediatric emergency department (PED) visits, analyse the main paediatric illnesses and establish associations of these demographics with the readmission rates and severity of their presentation. Methods: A retrospective analysis of neonates (aged < 28 days) presenting to the PEDs of our hospital over seven months was performed. Associations between the clinical and demographic data of admissions to the PED and inpatient admissions were analysed. Results: In total, 1,200 neonates presented during the study period, 79.4% of whom presented at less than 15 days since birth. Length of stay in the PED was less than four hours for 94.0% of the neonates. Predominant triage categories comprised non-P1 cases (97.5%). The main diagnoses at the PED were neonatal jaundice (NNJ; 66.8%) and neonatal pyrexia (NNP; 14.6%), which corresponded to the main diagnoses upon discharge from the hospital: NNJ (68.4%) and NNP (19.6%). 48.2% of neonates were referred from polyclinics or other clinics. 57.7% of the neonates were admitted. Interestingly, 87.0% of the well babies who presented to the emergency department were brought in owing to parental concerns by the parents themselves, without prior consultation with the doctor. Conclusion: Outpatient management of NNJ can be considered. Caregivers should be provided better education regarding normal physiological characteristics of newborns through standardised educational materials. Other potential avenues for parents to seek medical advice, for example hotlines and ChatBots such as the recently piloted ‘Urgent Paediatric Advice Line’ online service, should be considered.


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