Investigating Associated Factors Between Admission to Pediatric Emergency and Referral to Intensive Care Unit: A Retrospective Cohort Study
Abstract
Aim: We aimed to evaluate the patients who were admitted to Pediatric Emergency Department regarding the ratio of referral to Intensive Care Unit (ICU), and the relationship between the time of waiting in Emergency Department and the length of stay in Intensive Care Unit between January 2013 and December 2018.
Methods: The patients’ records who were admitted to our Pediatric Emergency Department between January 2013 and December 2018 were evaluated retrospectively. The referrals to Neonatal and Pediatric ICU were evaluated. Due to the absence of an Intensive Care Unit in our hospital, we compared the duration of referral to ICU and length of stay in ICU.
Results: The total number of patients who were admitted to Emergency Service was 673023, the number of the patients referred to ICU was 1327, 302 of these patients were referred to the Pediatric ICU (PICU), and the rest of them were referred to Neonatal ICU (NICU). While 47.35% of the patients who were referred to the PICU presented with respiratory tract diseases, 19.86% had neurological causes, 13.9% were intoxications, and 7.8% were gastrointestinal causes. 28.78% of the patients who were referred to the PICU had an accompanying chronic disease at the time of admission. Mean duration of referral to the PICU was 8.4 ± 6.3 hours. The length of stay of in PICU in 2017 and 2018 was investigated by asking on the phone (n = 122), and the mean length of stay of the patients in the PICU was 5.18 ± 2.1 days. There was no statistically significant correlation between the duration of referral to the ICU and the length of stay in the PICU (p; 0.089), whereas in 54 patients who presented to the emergency department due to respiratory distress and had no underlying chronic disease, there was a statistically significant correlation between the duration of referral to ICU and the length of stay in ICU (p: 0.012).
Conclusion: The number of Pediatric Emergency Department admissions is very high in our country and most of these patients present with respiratory complaints. 0.19% of the patients who were admitted to the emergency service were in need of intensive care. Patients who had no underlying disease and who needed intensive care for respiratory distress were shown to have a shorter length of stay, and their referrals were faster. These patients should be referred to intensive care units without delay in the emergency service. As a conclusion, there is a need for more PICU in our country.
Supporting Institution
yok
Project Number
yok
Thanks
yok
References
- 1. Definition of an Emergency Service. Annals of Emergency Medicine. 1994;23(6):1397-1398. 2. Kimberly W, McDermott Ph.D., Carol Stocks Ph.D., R.N., and William J. Freeman, M.P.H. Overview of pediatric emergency department visits. 2015; Healthcare Cost And Utilization Project 3. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-Term Trends in Health. Table 73. Emergency Department Visits Within the Past 12 Months Among Children Under Age 18, by Selected Characteristics: United States, Selected Years; 1997–2015. Centers for Disease Control and Prevention, National Center for Health Statistics. www.cdc.gov/nchs/data/hus/hus16.pdf#073. Accessed, November 2018. 4. Wier LM, Yu H, Owens PL, Washington R. Overview of children in the emergency department, 2010. HCUP Statistical Brief #157. June 2013. Agency for healthcare research and quality, Rockville, MD. www.hcupus.ahrq.gov/reports/statbriefs/sb157.pdf 5. Cohen HA, Blau H, Hoshen M, Batat E, Balicer RD. Seasonality of asthma: a retrospective population study. Pediatrics. 2014;133(4):e923-32. 6. Ruddy MR. Evaluation of respiratory emergencies in infants and children. Clin Ped Emerg Med. 2002;3:56-62. 7. Çocuk Acil Tıp veYoğun Bakım Derneği- Türkiye'deVeDünya'da Çocuk Acil Tıp HizmetleriMevcut Durum Ve Öneriler 2008. 8. Öztürk MA, Güneş T. Acil Hastanın özellikleri ve acil hastaya yaklaşım. Pediatri Özel Dergisi. 2004;(2):6. 9. Türkiye’deÇocukYoğunBakımHizmetleriMevcut Durum veÖneriler 2006 ///C:/Users/CothyNet/Downloads/Documents/cocuk_yogun_bakim_raporu.pdf 10. Hague A. Siddiqui NR, Jafri SK, Hoda M, Bano S, Mian A. Clinical profiles and outcomes of children admitted to the pediatric intensive care unit from the emergency department. J Coll Physicians Surg Pak. 2015;25(4):301-3. 11. Odetola F, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatr Crit Care Med. 2008;9(1):20-5. 12. Evans JM, Dayal P, Hallam DL, Natale JE, Kodali P, Sauers- Ford HS, et al. Illness severity of children admitted to the PICU from referring emergency departments. Hosp Pediatr. 2018; 8(7):404-409. 13. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184:213-6. 14. Hoot NR, Aronsky D. Systematic review of emergency department crowding: Causes, effects, and solutions. Ann Emerg Med. 2008;52:126-36. 15. Miró O, Antonio MT, Jiménez S, et al. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med. 1999;6:105–7. 16. Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via western Australian emergency departments. Med J Aust. 2006. 184:208–12. 17. Chan M, Meckler G, Doan Quynh. Paediatric emergency department overcrowding and adverse patient outcomes. Paediatr Child Health. 2017;22(7):377–381. 18. O'Mahony L, O’Mahony DS, Simon TD, Neff J, Klein EJ, Quan, L. Medical complexity and pediatric emergency department and inpatient utilization. Pediatrics. 2013;131(2):e559-65.
Investigating Associated Factors Between Admission to Pediatric Emergency and Referral to Intensive Care Unit: A Retrospective Cohort Study
Abstract
Aim: We aimed to evaluate the patients who were admitted to Pediatric Emergency Department regarding the ratio of referral to Intensive Care Unit (ICU), and the relationship between the time of waiting in Emergency Department and the length of stay in Intensive Care Unit between January 2013 and December 2018.
Methods: The patients’ records who were admitted to our Pediatric Emergency Department between January 2013 and December 2018 were evaluated retrospectively. The referrals to Neonatal and Pediatric ICU were evaluated. Due to the absence of an Intensive Care Unit in our hospital, we compared the duration of referral to ICU and length of stay in ICU.
Results: The total number of patients who were admitted to Emergency Service was 673023, the number of the patients referred to ICU was 1327, 302 of these patients were referred to the Pediatric ICU (PICU), and the rest of them were referred to Neonatal ICU (NICU). While 47.35% of the patients who were referred to the PICU presented with respiratory tract diseases, 19.86% had neurological causes, 13.9% were intoxications, and 7.8% were gastrointestinal causes. 28.78% of the patients who were referred to the PICU had an accompanying chronic disease at the time of admission. Mean duration of referral to the PICU was 8.4 ± 6.3 hours. The length of stay of in PICU in 2017 and 2018 was investigated by asking on the phone (n = 122), and the mean length of stay of the patients in the PICU was 5.18 ± 2.1 days. There was no statistically significant correlation between the duration of referral to the ICU and the length of stay in the PICU (p; 0.089), whereas in 54 patients who presented to the emergency department due to respiratory distress and had no underlying chronic disease, there was a statistically significant correlation between the duration of referral to ICU and the length of stay in ICU (p: 0.012).
Conclusion: The number of Pediatric Emergency Department admissions is very high in our country and most of these patients present with respiratory complaints. 0.19% of the patients who were admitted to the emergency service were in need of intensive care. Patients who had no underlying disease and who needed intensive care for respiratory distress were shown to have a shorter length of stay, and their referrals were faster. These patients should be referred to intensive care units without delay in the emergency service. As a conclusion, there is a need for more PICU in our country.
Project Number
yok
References
- 1. Definition of an Emergency Service. Annals of Emergency Medicine. 1994;23(6):1397-1398. 2. Kimberly W, McDermott Ph.D., Carol Stocks Ph.D., R.N., and William J. Freeman, M.P.H. Overview of pediatric emergency department visits. 2015; Healthcare Cost And Utilization Project 3. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-Term Trends in Health. Table 73. Emergency Department Visits Within the Past 12 Months Among Children Under Age 18, by Selected Characteristics: United States, Selected Years; 1997–2015. Centers for Disease Control and Prevention, National Center for Health Statistics. www.cdc.gov/nchs/data/hus/hus16.pdf#073. Accessed, November 2018. 4. Wier LM, Yu H, Owens PL, Washington R. Overview of children in the emergency department, 2010. HCUP Statistical Brief #157. June 2013. Agency for healthcare research and quality, Rockville, MD. www.hcupus.ahrq.gov/reports/statbriefs/sb157.pdf 5. Cohen HA, Blau H, Hoshen M, Batat E, Balicer RD. Seasonality of asthma: a retrospective population study. Pediatrics. 2014;133(4):e923-32. 6. Ruddy MR. Evaluation of respiratory emergencies in infants and children. Clin Ped Emerg Med. 2002;3:56-62. 7. Çocuk Acil Tıp veYoğun Bakım Derneği- Türkiye'deVeDünya'da Çocuk Acil Tıp HizmetleriMevcut Durum Ve Öneriler 2008. 8. Öztürk MA, Güneş T. Acil Hastanın özellikleri ve acil hastaya yaklaşım. Pediatri Özel Dergisi. 2004;(2):6. 9. Türkiye’deÇocukYoğunBakımHizmetleriMevcut Durum veÖneriler 2006 ///C:/Users/CothyNet/Downloads/Documents/cocuk_yogun_bakim_raporu.pdf 10. Hague A. Siddiqui NR, Jafri SK, Hoda M, Bano S, Mian A. Clinical profiles and outcomes of children admitted to the pediatric intensive care unit from the emergency department. J Coll Physicians Surg Pak. 2015;25(4):301-3. 11. Odetola F, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatr Crit Care Med. 2008;9(1):20-5. 12. Evans JM, Dayal P, Hallam DL, Natale JE, Kodali P, Sauers- Ford HS, et al. Illness severity of children admitted to the PICU from referring emergency departments. Hosp Pediatr. 2018; 8(7):404-409. 13. Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184:213-6. 14. Hoot NR, Aronsky D. Systematic review of emergency department crowding: Causes, effects, and solutions. Ann Emerg Med. 2008;52:126-36. 15. Miró O, Antonio MT, Jiménez S, et al. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med. 1999;6:105–7. 16. Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via western Australian emergency departments. Med J Aust. 2006. 184:208–12. 17. Chan M, Meckler G, Doan Quynh. Paediatric emergency department overcrowding and adverse patient outcomes. Paediatr Child Health. 2017;22(7):377–381. 18. O'Mahony L, O’Mahony DS, Simon TD, Neff J, Klein EJ, Quan, L. Medical complexity and pediatric emergency department and inpatient utilization. Pediatrics. 2013;131(2):e559-65.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Orginal Article |
| Authors | |
| Project Number | yok |
| Publication Date | December 20, 2020 |
| Published in Issue | Year 2020 |