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Paediatric utilization of a general emergency department in a developing country
A Y Goh1, T L Chan, M E Abdel-Latiff
1Department of Pediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. adriangoh@um.edu.my
Insights
Pediatric emergency departments see many young children with injuries, fever, and breathing issues. Training should focus on trauma, infections, and asthma to improve care quality.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
Background:
- Understanding pediatric emergency department (ED) patient demographics is crucial for resource allocation and quality improvement in developing countries.
- A significant proportion of pediatric ED attendees are young children, highlighting the need for specialized pediatric care.
Purpose of the Study:
- To determine the spectrum and frequency of pediatric emergencies presenting to an urban emergency department.
- To identify key diagnoses and patient characteristics associated with admission risk.
Main Methods:
- A prospective 6-week review of all pediatric (<18 years) patients attending an urban ED.
- Data collected included patient age, presenting complaints, diagnoses, arrival time, and disposition.
- Statistical analysis was performed to identify factors associated with admission.
Main Results:
- 1172 pediatric patients were analyzed, with 43% aged 4 years or younger.
- Common presenting complaints included injuries (26.9%), fever (24%), and breathing difficulties (16.6%).
- The most frequent diagnoses were minor trauma (24.2%), asthma (12.6%), and infections (12.1% each).
Conclusions:
- The study identified a broad range of pediatric illnesses in the ED, with a notable overrepresentation of young children.
- Recommendations include establishing dedicated pediatric EDs or staff, and tailoring training to common conditions like trauma, infections, and asthma.
- Developing guidelines for the most frequent complaints could enhance care for all ED staff.
Aim:
Knowledge of the spectrum and frequencies of pediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally.
Methods:
A prospective 6 wk review of all pediatric (< 18 y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded.
Results:
Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean +/- SD 6.9 +/- 5.6 y); 43% were aged < or = 4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (< 1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission.
Conclusion:
A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate pediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of pediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED.