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The spectrum and frequency of illness presenting to a pediatric emergency department
B S Krauss1, T Harakal, G R Fleisher
1Department of Emergency Medicine, Cambridge Hospital, Massachusetts.
Insights
Pediatric emergency departments see many young children, primarily for infections and trauma. Training should focus on these common conditions and trauma management for physicians.
Area of Science:
- Emergency Medicine
- Pediatrics
- Public Health
Background:
- Understanding pediatric emergency department (PED) patient demographics and common conditions is crucial for effective physician training.
- Existing data on the spectrum and frequency of pediatric emergencies are essential for curriculum development.
Purpose of the Study:
- To analyze the spectrum and relative frequencies of pediatric emergencies.
- To describe the patient population in a large PED by age, chief complaints, diagnoses, and disposition.
- To identify seasonal variations and peak arrival times for pediatric emergencies.
Main Methods:
- Retrospective review of log entries from a large PED over four one-week periods (January, April, July, October).
- Data collected included patient age, chief complaints, diagnoses, time of arrival, and disposition.
- Analysis of 3784 complete patient records.
Main Results:
- The majority of PED visits (50%) were by children aged three years or younger.
- Common chief complaints and diagnoses were related to infection and trauma.
- Most patients (over 50%) arrived during the evening shift (4 pm - 12 am).
- Admission rates varied by shift, with 13% of night shift patients admitted.
Conclusions:
- PED training curricula should emphasize management of infections and minor trauma.
- Non-pediatric emergency specialists require training focused on infection management.
- Pediatric emergency medicine fellows need comprehensive training in both pediatric and adult trauma.
Abstract:
Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for physicians treating children in emergency departments. To provide these data, we reviewed the records for four one-week periods (January, April, July, and October) of a large pediatric emergency department to describe the population in terms of age, chief complaints, diagnoses, time of arrival, seasonal variation, and disposition. There were 3796 log entries. Complete information on all variables was obtained on 3784 patients. Age ranged from one day to 39 years, and the mean age was 6.0 +/- 6.15 years. One half of all emergency department visits were by children three years old or younger. On the other hand, 12% of visits were by adolescents (ages 13 to 18), and one in 25 visits was made by an adult (greater than 18 years old). The majority of chief complaints and final diagnoses were related to infection and trauma. More than half of the patients arrived on the evening shift, between 4 pm and 12 am. Eleven percent of the children seen on day and evening shifts and 13% from the night shift were admitted. From the analysis of our data we recommend expanded skills in the management of minor trauma for pediatric residents, an emphasis on management of infections for nonpediatric emergency specialists, and extensive training in both pediatric and adult trauma for physicians in pediatric emergency medicine fellowships.