scholarly journals Effectiveness of a Training Course on Accuracy of Triaging of Pediatric Patients

2019 ◽  
Vol 7 (15) ◽  
pp. 2533-2537
Author(s):  
Mona Azzam ◽  
Enas Elngar ◽  
Ayman A. Gobarah
Keyword(s):  
Emergency Department ◽  
Health Care Professionals ◽  
Pediatric Patients ◽  
Surrogate Marker ◽  
Armed Forces ◽  
Pediatric Emergency ◽  
Training Course ◽  
Admission Rates ◽  
Significant Difference ◽  
Correct Determination

BACKGROUND: In the context of a new but busy Pediatric Emergency Department, the risk of missing patients who need more emergent care can be reduced by timely and accurate triaging. In the emergency department of King Fahad Armed Forces Hospital, the Canadian Triage and Acuity Scale had already been implemented, including the pediatric version (PaedCTAS). However, a common observation remained that critical patients did not always receive priority with subsequent delays in management. To improve this accuracy, a training course was administered to health care professionals responsible for triaging of pediatric patients. AIM: To determine the effectiveness of a training course on accuracy of triaging of Pediatric Patients. METHODS: A triage training course was conducted over two months, with patient encounter sheets reviewed before the course for 6 months and after the course for 12 months. Accuracy was calculated by comparing it to level as determined by two pediatric emergency physicians. Also, admission rates were used as a surrogate marker to also determine accuracy. RESULTS: A total of 31 053 patient sheets were reviewed. There was a considerable improvement in the correct determination of all triage levels, with accuracy ranging from 56.5% to 78.3% before the course, and reaching from 79.1% to 90.8% after the course with a statistically significant difference. Triaging errors still present were mainly in the form of down-triage. CONCLUSION: Our training course in triage has a significant impact on the accuracy of triaging of ill pediatric patients. Further improvement can be obtained by repeated courses and direct feedback with debriefing sessions on challenges to triage level determination.

scholarly journals Evaluation of the Efficacy of a Onetime Injectable Dexamethasone Administered Orally in the Pediatric Emergency Department for Asthma Exacerbation

2017 ◽  
Vol 22 (5) ◽  
pp. 326-331
Author(s):  
Ashley McCallister ◽  
Tsz-Yin So ◽  
Josh Stewart
Keyword(s):  
Emergency Department ◽  
Asthma Exacerbation ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Average Weight ◽  
Pediatric Emergency Department ◽  
Routes Of Administration ◽  
Efficacious Treatment ◽  
Randomized Control ◽  
To Receive

OBJECTIVE This study assessed the efficacy of injectable dexamethasone administered orally in pediatric patients who presented to the emergency department with asthma exacerbation. METHODS This was a retrospective study of patients 0 to 18 years of age who presented to and who were directly discharged from the emergency department at Moses H. Cone Memorial Hospital between September 1, 2012, and September 30, 2015, for the diagnosis of asthma or asthma exacerbation. Patients had to receive a onetime dose of injectable dexamethasone orally prior to discharge. Patients were followed for a 30-day period to identify the number of asthma relapses. RESULTS Ninety-nine patients were included in this study. The average weight-based dose ± SD of dexamethasone was 0.35 ± 0.18 mg/kg (range, 0.08–0.62 mg/kg) and the actual dose ± SD was 10.58 ± 1.92 mg (range, 5–16 mg). Over a 30-day period, 6 patients (6%) had one repeated emergency department visit, 6 patients (6%) were admitted to the hospital, and 3 patients (3%) presented to an outpatient clinic for asthma-related symptoms. CONCLUSIONS Injectable dexamethasone administered orally may be an efficacious treatment for asthma exacerbation in pediatric patients. A randomized control trial comparing injectable dexamethasone administered orally to other dexamethasone formulations/routes of administration should be performed to adequately assess the bioequivalence and effectiveness of the former formulation.

Characteristics of opioid prescriptions for discharged pediatric emergency department patients with acute injuries

2019 ◽  
Vol 67 (6) ◽  
pp. 1024-1027
Author(s):  
Lauren Krystine Kahl ◽  
Martha W Stevens ◽  
Andrea C Gielen ◽  
Eileen M McDonald ◽  
Leticia Ryan
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Median Number ◽  
Pediatric Emergency ◽  
Prescription Data ◽  
Prescribing Practices ◽  
Post Graduate ◽  
Frequent Use ◽  
Acute Injuries ◽  
Level Of Training

This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1–50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.

scholarly journals Incidence of bleeding in children undergoing circumcision with ketorolac administration

2017 ◽  
Vol 12 (1) ◽  
pp. E6-9 ◽  
Author(s):  
Bruce Gao ◽  
Taylor Remondini ◽  
Navraj Dhaliwal ◽  
Adrian Frusescu ◽  
Premal Patel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Pain Control ◽  
Pediatric Patients ◽  
Surgical Patients ◽  
Risk Of Bleeding ◽  
Perioperative Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference

Introduction: Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding.Methods: We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children’s Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review.Results: A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group 19/150 [13%], non-ketorolac group 16/325 [5.0%]; p=0.005). Patients receiving ketorolac were more likely to have postoperative sanguineous drainage (ketorolac group 96/150 [64%], non-ketorolac group 150/325 [46%]; p<0.001). There was no significant difference in the number of patients requiring postoperative admission or further medical intervention.Conclusions: Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.

scholarly journals Comparisons of Pediatric Patients who Visited to the Pediatric Emergency Department and the General Emergency Department

2015 ◽  
Vol 2 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Hyun Noh ◽  
Do Kyun Kim ◽  
Jin Hee Lee ◽  
Young Ho Kwak ◽  
Jin Hee Jung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Outcomes in Vaso-Occlusive Crisis Treatment in the Emergency Department Vs. Acute Care Observation Center

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-23
Author(s):  
Renee Cheng ◽  
Avani Singh ◽  
Xu Zhang ◽  
Priyanka Nasa ◽  
Jin Han ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Research Funding ◽  
Admission Rate ◽  
Pain Medication ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Data Set ◽  
Admission Rates ◽  
Significant Difference

I NTRODUCTION: Acute painful vaso-occlusive crises (VOC) are the leading cause of emergency department (ED) encounters and hospital admissions for those with sickle cell disease (SCD). For SCD patients, the goal of the sickle cell acute care observation unit (ACOU) at University of Illinois Health (UIH) is to improve patient outcomes by providing immediate care for an uncomplicated VOC. At our urban hospital which cares for more than 500 adult SCD patients, a considerable portion of SCD patients, despite having access to the ACOU, continue to present to the ED for treatment of an uncomplicated VOC. In order to help improve our current system, this study investigated outcomes in SCD patients who receive care for an uncomplicated VOC in the ACOU versus the ED at UIH. METHODS: By querying the electronic medical record, a retrospective study was conducted to analyze outcomes of encounters from the ACOU and ED at UIH between October 2019 and December 2019, specifically including SCD patients ≥18 years old who received morphine for treatment of an uncomplicated VOC. Encounters for complicated VOCs such as acute chest syndrome and stroke were excluded. Endpoints collected include time to first dose of morphine, total milligrams (mg) of IV morphine equivalents given, number of total morphine doses, admission rates, subsequent hospital length of stay, and 30-day inpatient admission rates. Time to the first dose (log transformed) and total dose in mg were analyzed by linear mixed effects models. The number of doses and hospitalization days were analyzed by negative binomial mixed effects model. Admissions and 30-day admissions were analyzed by logistic mixed effects models. These models adjusted for age, gender, and severe Hb genotype (HbSS or HbS beta0-thalassemia) and treated patient identity as random effect. P values were obtained from Wald- test. RESULTS: The ACOU data set contains 394 patient encounters for 79 patients with a median age of 33 years (interquartile range [IQR], 28-40), 71% female, and 73% with severe sickle genotypes. The ED data set contains 391 patient encounters for 128 patients with a median age of 30 years (IQR, 26-41), 53% female, and 74% with severe sickle genotypes. In the ACOU, the median time to first dose of morphine was 49 minutes (IQR, 39-60) compared to 107 minutes (IQR, 71-194) in the ED. The time to first dose was significantly longer in the ED compared to the ACOU (eβ=2.5, p &lt;2×10-16). There was no significant difference in the total number of morphine doses received nor the total mg of morphine received between the two locations. Admission rate from ACOU was 6.6% compared to 53% from ED (OR=0.019, p=2x10-16). Of those admitted, the median number of hospitalization days from the ACOU was 4 days (IQR, 2.3-5.8) and 4 days (IQR, 2.0-6.5) from the ED. There was no significant difference in hospitalization days (p=0.6). The 30-day admission rate was 55% from the ACOU compared to 58% from the ED. 30-day admission rate however had strong intra-patient correlation (i.e., a patient was likely re-admitted multiple times): 44% of patients from the ACOU had admissions within 30 days of their ACOU visit compared to 32% from the ED. Controlling for the intra-patient correlation, ACOU visits had a higher 30-day admission rate than ED visit (OR=2.8, p=0.0015). DISCUSSION: SCD patients treated for an uncomplicated VOC at the sickle ACOU at UIH had a significantly shorter time to initial dose of IV pain medication. The wait time in the ED before first dose of IV pain medication received was more than double than those treated in the ACOU. Patients treated for an uncomplicated VOC in ACOU and ED had similar hospitalization days without a statistically significant difference. The 30-day admission rate to the inpatient setting was comparable for those treated in the ED versus the ACOU. However, given that only 6.6% of patients from the ACOU were admitted during the study period, this suggests that most patients who use both the ED and ACOU tend to be subsequently admitted from the ED. SCD patients may be presenting to the ED for treatment of VOC if capacity in the ACOU is exceeded or are presenting outside of hours of operation (currently 2 shifts Monday through Saturday). Therefore, improving access to our ACOU by increasing capacity and hours of operation may subsequently also lead to a decrease in time to first dose of medication and decrease in the overall 30-day admission rate. Disclosures Gordeuk: Imara: Research Funding; CSL Behring: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; Novartis: Consultancy; Ironwood: Research Funding.

scholarly journals The appropriateness of referrals to a pediatric emergency department via a telephone health line

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 139-148 ◽  
Author(s):  
Tawfik Al-Abdullah ◽  
Amy C. Plint ◽  
Alyson Shaw ◽  
Rhonda Correll ◽  
Isabelle Gaboury ◽  
...  
Keyword(s):  
Emergency Department ◽  
Resource Use ◽  
Primary Outcome ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Lengths Of Stay ◽  
Triage Category ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Explicit Criteria

ABSTRACT Objective: We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral. Methods: A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED. Results: Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p &lt; 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes. Conclusion: There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.

scholarly journals Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

2020 ◽  
Vol 7 ◽  
pp. 2333794X2094792
Author(s):  
Samita Giri ◽  
Tine Halvas-Svendsen ◽  
Tormod Rogne ◽  
Sanu Krishna Shrestha ◽  
Henrik Døllner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Low Income ◽  
Disease Burden ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Low Income Countries ◽  
Post Discharge ◽  
Telephone Interviews ◽  
Pediatric Emergency Care

Background. In low-income countries, pediatric emergency care is largely underdeveloped although child mortality in emergency care is more than twice that of adults, and mortality after discharge is high. Aim. We aimed at describing characteristics, triage categories, and post-discharge mortality in a pediatric emergency population in Nepal. Methods. We prospectively assessed characteristics and triage categories of pediatric patients who entered the emergency department (ED) in a local hospital. Patient households were followed-up by telephone interviews at 90 days. Results. The majority of pediatric emergency patients presented with injuries and infections (~40% each). Girls attended ED less frequent than boys. High triage priority categories (orange and red) were strong indicators for intensive care need and for mortality after discharge. Conclusion. The study supports the use and development of a pediatric triage systems in a low-resource general ED setting. We identify a need for interventions that can reduce mortality after pediatric emergency care. Interventions to reduce pediatric emergency disease burden in this setting should emphasize prevention and effective treatment of infections and injuries.

Potential Impact of Linking an Emergency Department and Hospital-Affiliated Clinics to Immunize Pre-School-Age Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 99-103 ◽  
Author(s):  
Louis M. Bell ◽  
Nereida I. Lopez ◽  
Jennifer Pinto-Martin ◽  
Rosemary Casey ◽  
Frances M. Gill
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Preventive Health Care ◽  
Pediatric Emergency ◽  
School Age Children ◽  
Control Group ◽  
School Age ◽  
Significant Difference ◽  
Rubella Vaccination ◽  
Clinic Visits

Objective. To determine whether the use of an urban pediatric emergency department (ED) to immunize pre—school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life. Design. A retrospective cohort study of two groups: (1) 100 consecutive children (ED group) enrolled at one of two hospital-affiliated primary care clinics were chosen from the ED patient logs if their second birthday occurred in the 12 months prior to November 1990; and (2) 91 age-matched control children (control group) were chosen at random from the same hospital-affiliated clinics' enrollment logs without regard to ED use. The health care provided during the first 2 years of life for each group was compared. Results. The mean number of visits to the ED in the first 2 years of life by the ED group was significantly greater than that of the control group (2.9 [SD] ± 2.5 vs 1.1 ± 1.4; P &lt; .001) during the first 2 years of life. In 67% of ED visits, children would have been well enough to receive a vaccination. Both groups had similar types and numbers of visits to the primary clinics. For example, the ED group had 10 ± 5 visits by age 2 years compared with the control group, which had 9 ± 4 visits. There was no significant difference in actual immunization percentages achieved in the clinic, with 62% of the ED group having received four diphtheria, pertussis, and tetanus vaccinations; three oral poliovirus vaccinations; and one measles, mumps, and rubella vaccination by age 2 compared with 69% of control children. There were more missed vaccination opportunities during clinic visits in the ED group (7.4 vs 4.6 per 100 clinic visits; P &lt; .01). If immunizations were offered in the ED to those children who needed them, immunization percentages would have been increased an average of 20% compared with percentages achieved in the clinic alone. Conclusion. Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.

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