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Published on: February 9, 2011
Do pediatric emergency departments pose a risk of infection?
Caroline Quach1, Dorothy Moore, Francine Ducharme
1Infectious Diseases Division, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Center, (2300 Tupper Street), Montreal, (H3H 1P3), Canada. caroline.quach@mcgill.ca
Insights
A pediatric Emergency Department (ED) visit did not show an increased risk of infection in young children. Intra-familial infectious contact was the main predictor of new infections.
Area of Science:
- Pediatric healthcare
- Infectious disease epidemiology
- Public health
Background:
- Concerns exist regarding infection transmission in ambulatory healthcare settings.
- Limited data documents infection risk in pediatric Emergency Departments (EDs).
Purpose of the Study:
- To determine the infection risk associated with pediatric ED visits.
- To identify predictors of infection in children aged five years and under.
Main Methods:
- Children aged 5 years and under with ED visits were recruited and followed via telephone.
- Infection development was ascertained through interviews 7-10 days or at least 14 days post-visit.
- Logistic regression analyzed new infections and adjusted for confounders.
Main Results:
- Children with ED visits had a slightly lower infection rate (15.3%) compared to the unexposed group (23.4%).
- The relative risk (RR) for infection associated with ED exposure was 0.7 (95% CI 0.4-1.4).
- Intra-familial infectious contact was the sole predictor of increased infection risk (RR 9.9; 95% CI 1.7-58.9).
Conclusions:
- Pediatric ED visits do not appear to increase infection risk beyond community levels in young children.
- High baseline infection rates in young children may obscure a detectable ED-associated risk.
- Further studies are needed to definitively rule out any potential infection risk.
Background:
There is no data documenting the existence of a risk of infection transmission in ambulatory healthcare settings but concern remains. Our objective was to determine the risk of infection associated to a pediatric Emergency Department (ED) visit and the predictors of infection in children aged 5 years and less.
Methods:
Children aged 5 years and less with an ED visit between February and April of a non pandemic season were recruited and followed-up by telephone interviews to ascertain the development of new respiratory and gastrointestinal infections. Approximately half of the parents were called 7-10 days after their child's ED visit. The other half were called at least 14 days after the visit and served as the ED-unexposed group. The principal outcome was the onset of a new infection in the week preceding the phone interview, using standardized definitions. Proportions of children with new infections were calculated in both groups and logistic regression was used to adjust for potential confounders.
Results:
A total of 304 children (mean age 2.4 years) were followed. Of the 137 children with a recent ED visit, 21 (15.3%) developed an infection compared to 39 of 167 (23.4%) of those without a recent visit. The relative risk (RR) associated with ED exposure was 0.7 (95%CI 0.4-1.1). As 85 children with a recent ED visit presented to the ED with a viral infection, we repeated the analysis excluding them to improve our capacity to detect new infections: 9 children (17.3%) developed an infection (RR = 0.7 [95%CI 0.4-1.4]). The only factor associated with an increased risk of infection was an intra-familial infectious contact (RR 9.9; 95%CI 1.7-58.9).
Conclusion:
A visit to a pediatric ED does not result in a detectable increased risk of infection above the risk in the community. This is likely explained by the high baseline risk of infections in young children. However, we cannot eliminate the possibility that a risk of infection may still exist and would warrant a larger study to document.
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