OBJECTIVEThe aim of this study was to investigate the impact of air pollution on the number of pediatric outpatient and emergency room visits in January 2013.

METHODSHealth-related data was from a major hospital in Haidian,Beijing while related data on air pollution was from the Chinese Research Academy of Environmental Sciences. Data on weather was from the China Weather Website. Number of hospital outpatient visits per day during the haze period was compared to those from the previous year to get the increase of percentage. Concentration-response functions were estimated using generalized additive modeling with natural log link function, while multiple structural change test was used to determine the changing point in CRFs. Constrained piecewise linear function was used to estimate the risks for different segments of CRFs.

RESULTSThe peak of NO(X), SO₂, PM(2.5) and PM(10) reached 672.63 µ g/m³, 146.20 µ g/m³, 312.19 µ g/m³ and 995.00 µ g/m³, around 28 December 2012 and 10 January 2013. The peaks of visits to the pediatric department were observed at the some days, showing 47.75% and 34.14% of increase in the visits to the pediatric department. In the low or intermediate ranges of concentration, all the four air pollutants were significantly associated with pediatric outpatient visits, in the form of C- and S- shape of concentration-response function. However, in the range of high concentration, only PM(10) and SO₂were significantly associated with the number of visits to the pediatric emergency room, appeared as the J-shape form. Discernable thresholds were found in S- and J- shapes which were located at 200 µg/m³, 20 µg/m³, 40 µg/m³ and 100 µ g/m³ for NO(X), SO₂, PM(2.5) and PM(10), respectively.

CONCLUSIONAir pollution during the haze period was associated with the increase of pediatric outpatient and emergency room visits. There were different sensitive groups within the pediatric cases. Their susceptibility showed a decreasing trend from C-, S-, to J- shape related group.

Air Pollution ; adverse effects ; Child ; China ; epidemiology ; Emergency Service, Hospital ; utilization ; Humans ; Outpatients ; Weather

INTRODUCTIONHaemolysis of blood samples is a common problem encountered in the Emergency department (ED). It leads to inaccurate blood results and has cost implications as blood samples very often have to be retaken. The purpose of our study was to determine which factors in blood sampling were associated with higher rates of haemolysis.

MATERIALS AND METHODSAn observational convenience sample of all patients presenting to the ED requiring blood urea and electrolyte (UE) analysis were eligible for our study. Questionnaires were distributed to the doctors and nurses conducting blood sampling to determine the method used and outcome data were collected after the samples were processed.

RESULTSOut of 227 UE samples analysed, 45 (19.8%) were haemolysed. Various factors, including method (IV cannulation or venepuncture), system (syringe or vacutainer), operator, rate of blood flow, difficulty of cannulation/venepuncture and source of blood (arterial or venous), were analysed, but their effects on haemolysis were not statistically significant (P >0.05). However, the use of the vacutainer system was associated with the highest rates of haemolysis [adjusted odds ratio (OR), 6.0; 95% confidence interval (CI), 2.3 to 15.1].

CONCLUSIONWe found blood sampling with the vacutainer system to have increased rates of haemolysis. This could potentially change attitudes towards equipment used for blood sampling in the ED.

Catheters, Indwelling ; Data Collection ; Emergency Service, Hospital ; Hemolysis ; Humans ; Nurses ; Phlebotomy ; instrumentation ; methods ; Physicians ; Professional Competence ; Singapore ; Syringes ; utilization

Objective: To investigate the utilization of antibiotics in emergency departments (EDs) of class Ⅲ general hospitals in China. Methods: Data from a national monitoring network for rational use of drugs was used. The data included prescriptions of EDs from 114 class Ⅲ general hospitals in 30 provinces (autonomous regions, municipalities) of China. A total of 10 260 595 prescriptions from October 1, 2014 to December 31, 2016 were extracted. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose (DDD) system was used for the classification of antibiotics and calculation of antibiotic use intensity. An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs. Results: The rate of antibiotic prescriptions was 27.82% in EDs, among the antibiotics prescribed, 25.58% were for the combination therapy with 2 or more antibiotic agents, and injectable antibiotic prescriptions accounted for 60.59%. Besides, the number of DDDs per 100 patient visits was 81.84. Broad-spectrum agents were the most commonly used antibiotics, among which the second and third generation cephalosporins, quinolones and macrolides accounted for 23.83%, 21.68%, 19.17% and 7.89% of all prescribed antibiotics, respectively. The use of antibiotics, including prescription frequency and use intensity, in EDs had a slight but significant increase tendency (P<0.05), and the seasonal variation of antibiotic use in EDs was obvious, characterized by the highest frequency and intensity of antibiotic use in winter, the differences were significant (P<0.05). Conclusion: The antibiotic prescription rate in EDs of classⅢ general hospitals in China was controlled at a low level, but the proportions of broad-spectrum antibiotics and injectable antibiotics were high, and a significant increase trend in antibiotic use in EDs was found.
Anti-Bacterial Agents/therapeutic use* ; China ; Drug Prescriptions ; Drug Utilization ; Emergency Service, Hospital ; Hospitals ; Hospitals, General ; Humans

INTRODUCTIONThe aim of this study was to externally validate the Cham score for the prediction of bacteraemia in emergency department (ED) patients with non-hospital acquired pneumonia.

MATERIALS AND METHODSThis is a secondary analysis of a dataset collected to identify independent predictors of bacteraemia in adult ED patients with non-hospital acquired pneumonia. The primary outcome of interest was the predictive performance (sensitivity, specificity, negative predictive value) of the score with respect to bacteraemia. Secondary outcomes included the performance of the score in patients not known to be intravenous (IV) drug users, the predictive performance of pneumonia severity index (PSI) class IV/V and PSI class IV/V or IV drug use as predictors and the clinical impact of score application on test ordering. Data analysis was by clinical performance and receiver operator characteristic curve analysis.

RESULTSA total of 200 patients were studied; 14 true positive blood cultures (7%, 95% CI, 4% to 11%). The Cham score had a sensitivity of 92.9% (95% CI, 64.2% to 99.6%), specificity of 26.3% (95% CI, 20.3% to 33.4%) and negative predictive value (NPV) of 98% (87.0% to 99.9%). Area under the receiver operating characteristic (ROC) curve was 0.71 (95% CI, 0.56 to 0.86). Using PSI class IV/V or known IV drug use as predictors had sensitivity of 92.9% (95% CI, 64.2% to 99.6%), specificity of 51.1% (95% CI, 43.7% to 58.4%) and NPV of 99% (95% CI, 93.5% to 99.9%).

CONCLUSIONIn retrospective external validation, the Cham score performed better than in derivation with acceptable sensitivity and NPV. Simplified criteria (PSI class IV/V or known IV drug use), as yet not validated, had similar sensitivity and NPV but would avoid blood cultures in a higher proportion of patients.

Aged ; Aged, 80 and over ; Bacteremia ; blood ; diagnosis ; Bacteriological Techniques ; utilization ; Emergency Service, Hospital ; Female ; Hematologic Tests ; utilization ; Humans ; Male ; Middle Aged ; Pneumonia, Bacterial ; blood ; microbiology ; Retrospective Studies

OBJECTIVE: We wanted to assess the trends of CT examinations that were conducted in an adult emergency department (ED). MATERIALS AND METHODS: We searched the medical database to identify adult patients (> or = 18 years) who had visited the ED and the number of CT examinations of the patients during the period from January 2001 to December 2010. We also analyzed the types of CT scans performed in terms of body parts, they were as follows; head CTs, facial bone CTs, neckl CTs, chest CTs, abdominal CTs, and miscellaneous CTs. Further, miscellaneous CTs were subdivided as CT angiography and others. RESULTS: A total of 113656 CT scans were examined for 409439 adult ED patients during a 10-year period, and the number of CT scans increased by 255% (from 4743 CTs in 2001 to 16856 CTs in 2010), while the adult ED patient volume increased by 34% during the same period. Although the head CTs proportionally occupied the most, the facial bone CTs had the largest rate of increase (3118%), followed by cervical CTs (1173%), chest CTs (455%), miscellaneous CTs (388%; 862% and 84% for CT angiography and others, respectively), abdominal CTs (315%) and head CTs (95%) per 1000 patients during the decade. CONCLUSION: CT use in adult ED has increased at a rate that far exceeds the growth of ED patient volume, with facial bone CTs and cervical CTs having the largest increasing rate, followed by chest CTs, miscellaneous CTs, abdominal CTs and head CTs.
Adult ; Emergency Service, Hospital/*utilization ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed/*utilization

After-Hours Care ; Attitude of Health Personnel ; Attitude to Health ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital ; utilization ; Humans ; Medical Overuse ; Parents ; Pediatrics ; Primary Health Care ; Singapore ; Surveys and Questionnaires

This study was conducted to examine the nation-wide emergency department (ED) utilization pattern by children in Korea. Most referral hospital EDs provide their essential ED information to the National Emergency Medical Center through the National Emergency Department Information System (NEDIS). We analyzed the NEDIS data on pediatric visits (< 19 yr old) during three years, from June 1, 2008 to May 31, 2010. A total of 2,072,664 children visited 124 EDs during the study period, and this patient population comprised 31.2% of the total ED visits. Male patients with a mean age of 5.44 (+/- 5.40 SD) yr comprised 59.1% of the ED pediatric visits. Among all age groups, the 1-4-yr-old group was the largest (42.3%). The most common mode of arrival was non-emergency medical service (EMS) (90.7%), and only 4.2% of patients used EMS transport. Common chief complaints in infants were fever (37.4%), whereas many older children presented to the EDs with abdominal pain (15.4%). The ratio of disease versus injury as the cause of ED visits was 2.5:1. Most patients were discharged (81.2%), and 15.3% were admitted. In conclusion, the most common age group who are brought to EDs in Korea is 1 to 4 yr-old young children, and common chief complaints of the visiting children are age-dependent, such as fever in younger children and abdominal pain and headache in older children. We need more improved and organized emergency medicine service system for children in Korea.
Abdominal Pain/diagnosis ; Adolescent ; Child ; Child, Preschool ; Critical Illness ; Demography ; *Emergency Medical Services ; Emergency Service, Hospital/*utilization ; Female ; Fever/diagnosis ; Humans ; Infant ; Infant, Newborn ; Length of Stay ; Logistic Models ; Male ; Patient Admission ; Republic of Korea ; Wounds and Injuries/diagnosis

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.
Accidents, Traffic/mortality/*prevention & control ; Adult ; Aged ; Craniocerebral Trauma/prevention & control ; Databases, Factual ; Emergency Service, Hospital ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Motor Vehicles ; Odds Ratio ; Republic of Korea/epidemiology ; Seat Belts/*utilization ; Young Adult

OBJECTIVE: We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). MATERIALS AND METHODS: We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 years and 13 < or = ages < 18 years). RESULTS: The number of CTs performed per 1000 patients increased by 92% during the 10-year period (per 1000 patients, increased from 50.1 CTs in 2001 to 156.5 CTs in 2006, and then decreased to 96.0 CTs in 2010). Although head CTs were performed most often (74.6% of all CTs), facial bone CTs showed the largest rate of increase (3188%) per 1000 patients, followed by cervical CTs (642%), abdominal CTs (474%), miscellaneous CTs (236%), chest CTs (89%) and head CTs (39%). The number of patients who had CT examinations for multiple regions in the same day showed a similar pattern of increase, to that of overall CT examinations. Increase of CT utilization was more pronounced in adolescents than in pediatric patients younger than 13 years (189% vs. 59%). CONCLUSION: The utilization of CTs increases from 2001 to 2006, and has declined since 2006. The increase of CTs is more pronounced in adolescents, and facial bone CTs prevail in increased number of examination followed by cervical CTs, abdominal CTs, miscellaneous CTs, chest CTs, and head CTs.
Adolescent ; Child ; Child, Preschool ; Emergency Service, Hospital/statistics & numerical data/*trends ; Female ; Humans ; Male ; Multidetector Computed Tomography ; Republic of Korea ; Tertiary Care Centers/statistics & numerical data/*trends ; Tomography, X-Ray Computed/*trends/utilization

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.
Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital/utilization ; Female ; Humans ; Male ; Patient Discharge/*statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Self-Injurious Behavior/*psychology ; Suicide, Attempted/*psychology ; Treatment Refusal/*psychology ; Young Adult