Challenges and solutions: pandemic 2009 H1N1 influenza A in a pediatric emergency department
James Graham1, Steven Shirm, Elizabeth Storm
1Department of Pediatrics, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Insights
The 2009 H1N1 influenza pandemic caused a surge in pediatric emergency department (ED) visits, overwhelming resources. Despite high patient volumes, influenza-like illness (ILI) cases had a lower admission rate than other conditions.
Area of Science:
- Public Health
- Epidemiology
- Pediatric Emergency Medicine
Background:
- The 2009 H1N1 influenza pandemic presented a significant public health challenge.
- Understanding the impact on pediatric healthcare systems is crucial for preparedness.
Purpose of the Study:
- To describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED).
- To analyze patient volumes and admission rates during the pandemic.
Main Methods:
- Prospective surveillance of influenza-like illness (ILI) in a pediatric ED.
- Retrospective review of patient admissions for ILI and non-ILI cases.
- Comparison of monthly patient census data with historical data.
Main Results:
- A rapid increase in ILI patients occurred after schools reopened in August 2009.
- September 2009 recorded the highest patient census ever for the ED.
- The admission rate for ILI patients (10.8%) was lower than for non-ILI patients (14.8%) from September to November 2009.
Conclusions:
- The H1N1 pandemic caused unprecedented patient volumes in the pediatric ED.
- Pandemic influenza can strain emergency care resources, even with lower overall illness severity.
- Preparedness for surges in pediatric emergency care is essential.
Objective:
The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009.
Design:
In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data.
Results:
When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent).
Conclusions:
The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.
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