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HIV-infected children in the pediatric emergency department
H Pinkert1, M B Harper, T Cooper
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
Insights
HIV-positive children frequently visited the Emergency Department (ED) with infections, often requiring hospitalization. Early identification of serious infections in these pediatric patients is crucial for timely intervention.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric HIV/AIDS Management
- Emergency Medicine
Background:
- Human Immunodeficiency Virus (HIV) infection impacts children, necessitating specialized care.
- The Children's Hospital AIDS Program monitored HIV-positive children, tracking their healthcare needs.
Purpose of the Study:
- To analyze the characteristics and outcomes of Emergency Department (ED) visits by HIV-positive children.
- To identify common reasons for ED visits and diagnoses in this pediatric population.
Main Methods:
- Retrospective review of 184 ED visits by 43 HIV-positive children between 1988-1989.
- Analysis of chief complaints, ED discharge diagnoses, CD4 counts, and blood culture results.
- Comparison of characteristics between hospitalized and discharged patients.
Main Results:
- Fever (50%) and respiratory symptoms (21%) were chief complaints; acute infections identified in 62% of visits.
- Pneumonia (17%) and fever/possible sepsis (25%) were common ED diagnoses.
- 53% of encounters resulted in hospitalization, with higher temperatures and white blood cell counts associated with admission.
Conclusions:
- HIV-positive children present to the ED with significant infectious burdens, often requiring hospitalization.
- Prompt evaluation and management are essential for this vulnerable pediatric population.
- Further research into optimizing ED care for HIV-infected children is warranted.
Abstract:
Forty-three nonhemophiliac, confirmed HIV-positive children followed by the Children's Hospital AIDS Program made 184 visits to the children's Emergency Department (ED) during 1988 and 1989. The mean age was 30 +/- 28 months with a median of 25 months, a mode of 10 months, and a range from two days to 19 years. CD4 counts from within six months of the visit were available in 87% and were low enough to require Pneumocystis carinii pneumonia prophylaxis under current guidelines in 52%. Chief complaints included fever in 50%, respiratory symptoms in 21%, and gastrointestinal symptoms in 8%. The ED discharge diagnosis included fever/possible sepsis in 25%, pneumonia in 17%, otitis media in 9%, and upper respiratory tract infection or viral syndrome in 9%. Overall, an acute infection was identified at 62% of visits; of these, 33% were judged to be serious in nature. A total of 92 blood cultures were drawn, of which eight were positive with the following organisms: Streptococcus pneumoniae (3), Streptococcus faecalis (2), Escherichia coli (1), Torulopsis glabrata (1), and Staphylococcus non-aureus (1, a probable contaminant). Overall, 53% of patient encounters resulted in hospitalization. Patients with a white blood cell count more than 15,000/mm3 were more likely to be hospitalized (87 vs 62%, P < 0.01), though the white blood cell count was not helpful in identifying patients with bacteremia or serious infections. The mean temperature of patients admitted was higher than in those discharged (38.7 vs 37.9 degrees C, P < 0.01). In 1989, an estimated six per 1000 visits to our facility were by HIV-infected children.