Herlyn-Werner-Wunderlich (HWW) syndrome is a rare, congenital genitourinary anomaly involving the Müllerian and Wolffian structures, and is characterized by the triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents in adolescent girls in whom hematometrocolpos produces a pronounced mass effect and pain on the side of the obstructed hemivagina. Accurate diagnosis and surgical treatment can be delayed for several months or even years. Here, we report a case of a 12-year-old girl who presented to the emergency department with lower abdominal pain and mass that had lasted for 2 weeks. After the confirmation of HWW syndrome with magnetic resonance imaging, hysteroscopic septostomy was carried out as a definitive treatment. When we evaluate adolescent girls with lower abdominal pain and mass, we should consider the possibility of HWW syndrome.
Abdominal Pain ; Adolescent ; Child* ; Diagnosis ; Emergency Service, Hospital ; Female* ; Hematocolpos ; Humans ; Magnetic Resonance Imaging ; Mullerian Ducts ; Wolffian Ducts

PURPOSE: Increasing visit of children to emergency departments (EDs) necessitates the effort to expand pediatric emergency medicine resources. We conducted this study to understand the epidemiologic characteristics of children who visited a community hospital ED. METHODS: The medical records of 32,031 children aged younger than 18 years were reviewed retrospectively from January 2013 to December 2015. We analyzed the age distribution, season, day, and time of visit, cause of visit, test performed, initial diagnosis, injury mechanisms, and disposition. RESULTS: Mean age of the children was 6.2±5.1 years and boys accounted for 59.1%. Children who had disease (65.5%) and aged 1 to 4 years (41.9%) accounted for the largest population. There was no difference of age distribution through seasons (P = 0.07). The proportions of children with disease and injury were the highest during winter (72.5%) and autumn (38.2%), respectively (P < 0.001). Children tended to visit the ED more frequently during non-business hours. In particular, children who aged 1 to 4 years, had disease or were slight ill visited the ED more frequently during this period (P < 0.001). Plain abdomen radiographs and urinalyses were performed to 29.8% and 16.1% of the children, respectively. Functional gastrointestinal disorder (20.3%) and laceration (30.1%) were the most common initial diagnoses among the children with disease and injury, respectively. The most common injury mechanism was struck injury (29.7%). After the treatment, 94.4% of the children were sent home from the ED. Of the remaining children, 5.5% were admitted, 0.1% were transferred to other hospitals, and 0.04% expired. CONCLUSION: Children who aged 1 to 4 years, had disease or were slight ill visited the ED more frequently during non-business hours than business hours. Pediatric emergency medicine resources should be expanded in consideration of this.
Abdomen ; Age Distribution ; Child* ; Commerce ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Epidemiology ; Gastrointestinal Diseases ; Hospitals, Community ; Humans ; Lacerations ; Medical Records ; Retrospective Studies ; Seasons ; Urinalysis ; Urinary Tract Infections

PURPOSE: To investigate whether performance of point-of-care ultrasound (POCUS) can reduce emergency department length of stay (EDLOS) for children with nonspecific manifestations of intussusception (NMI), defined as 2 or less manifestations of the classic triad of intussusception, and/or vomiting. METHODS: We reviewed medical records of 141 consecutive children with intussusception aged 6 years or younger who visited the emergency department of Asan Medical Center in Seoul, Korea from May 2014 through April 2016 and underwent diagnostic radiology ultrasound and pneumatic reduction. The children were grouped according to whether they underwent POCUS or not (POCUS and no POCUS groups, respectively). POCUS was performed to children with NMI by an attending emergency physician who had completed a POCUS training course endorsed by the Korean Society of Pediatric Emergency Medicine. We measured EDLOS, which consisted of door-to-reduction and observation times. These time intervals were compared between the 2 groups. RESULTS: Of 112 eligible children, 65 (58%) underwent POCUS. The median EDLOS was shorter in the POCUS group than in the no POCUS group (566 minutes, interquartile range [IQR] 497 to 765 vs. 745 minutes, IQR 551 to 981; P = 0.003). The median door-to-reduction and observation times were also shorter in the POCUS group (105 vs. 138 minutes, P < 0.001 and 440 vs. 628 minutes, P = 0.008, respectively). These differences were possibly due to the performance of POCUS and the trend toward early discharge after pneumatic reduction. We found 1 child with false negative result on POCUS, but there may have been more. CONCLUSION: Performance of POCUS may reduce EDLOS in children with NMI.
Child* ; Chungcheongnam-do ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intussusception* ; Korea ; Length of Stay* ; Medical Records ; Point-of-Care Systems* ; Seoul ; Ultrasonography* ; Vomiting

Knowing a pediatric patient's weight is crucial in resuscitation since the decision on the dose of resuscitation drug and the size of the instrument is made mostly based on a patient's weight. However, using a scale may not always be practical in resuscitation. Therefore, it is important to know the methods of weight estimation in resuscitation. The weight estimation can be performed based on various factors: visual assessment, age, height, and body habitus. One of the most common problems of these methods is that the weight tends to be underestimated as a patient's age increases. This is due to an inappropriate reflection of body habitus. Further research is needed to overcome this problem.
Body Weight ; Child ; Emergency Service, Hospital ; Humans ; Infant ; Methods* ; Resuscitation*

After-hours care (AHC) provides urgent primary care at nighttime, weekends, and holidays. In Korea, individual primary care physicians seldom participate in AHC and many parents have difficulty in receiving primary care during non-office hours without going to an emergency department (ED). The ED is currently the only place to access a full range of services at any time. However, the ED is not optimized for AHC, and using it for AHC is not an efficient use of resources. Therefore, many countries are seeking a safe, efficient non-ED AHC model which provides the best care considering the limitations. Different models for AHC exist worldwide, varying from family doctor-based to hospital-based models, and some countries use several different models including 24-hr telephone triage and advice services (TTA). Common problems of AHC include the inaccessibility to primary care, discontinuity of care, expensive healthcare costs, and work dissatisfaction among health care professionals. These are the major reasons for the recent changes made to the AHC system in many countries, such as the integration into one single national TTA in the United Kingdom, support for group practices in Canada, reorganization of small practice rotation groups into large scaled, general practitioner cooperatives in the Netherlands, and rapid expansion of the urgent care industry in the United States. This review presents a brief overview of the current AHC in Korea and the need for an effective non-ED AHC model. An effective AHC system will improve the quality of care, financial saving, and job satisfaction of the health care professionals.
After-Hours Care* ; Ambulatory Care ; Ambulatory Care Facilities ; Canada ; Child ; Delivery of Health Care ; Emergency Service, Hospital ; General Practitioners ; Great Britain ; Group Practice ; Health Care Costs ; Holidays ; Humans ; Job Satisfaction ; Korea ; Netherlands ; Night Care ; Parents ; Physicians, Primary Care ; Primary Health Care ; Telephone ; Triage ; United States

Although Bell's palsy is the most common cause of facial palsy in children, some cases have potentially fatal causes. We report a rare case of isolated facial palsy in a 4-year-old girl whose diagnosis was acute myeloid leukemia with extramedullary infiltration. The findings of laboratory investigations were nonspecific at presentation except that the delta neutrophil index was 34.5% (reference range, 0%–5%). To avoid hasty diagnosis of Bell's palsy in children with isolated facial palsy, vigilant differential diagnosis and workup are recommended.
Bell Palsy ; Child ; Child, Preschool* ; Diagnosis ; Diagnosis, Differential ; Facial Paralysis* ; Female* ; Humans ; Leukemia, Myeloid, Acute* ; Magnetic Resonance Imaging ; Neutrophils*

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*

PURPOSE: To investigate the factors associated with discharge of children from the emergency department (ED) after interfacility transfer. METHODS: We reviewed consecutive children who visited the ED via interfacility transfer from January 2014 to December 2015. The children were divided into two groups according to whether they were discharged from the ED or not (the discharge and admission groups), and their characteristics were compared. Multivariable logistic regression analysis was performed to identify the factors associated with discharge of children from the ED after interfacility transfer. RESULTS: Of the 999 transferred children, 426 (42.6%) were discharged. Compared to the admission group, these children showed older age, more frequent transfers from clinics and arrivals between 16 h and 20 h, shorter stay in the ED, and less frequent surgical abdomen. We found that age (3 to 6 years; adjusted odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3–2.6, compared with 0 to 2 years), diagnosis (trauma; OR, 2.4; 95% CI, 1.5–4.0, compared with gastrointestinal diseases), and referring hospital (primary clinic; OR, 5.4; 95% CI, 3.1–9.4, compared with tertiary hospitals) were the factors. CONCLUSIONS: The children who aged 3 to 6 years, had trauma or underwent transfers from primary clinics were more likely to be discharged at the ED. Considering these factors, we should reduce unnecessary transfers.
Abdomen ; Child* ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Logistic Models ; Odds Ratio ; Patient Discharge ; Patient Transfer ; Pediatrics

Neonates include both full term and preterm infants up to 28 days of age. The heterogeneity and rapid physiologic change of neonates affect all aspects of pharmacokinetics such as absorption, distribution, metabolism, and elimination. This feature should be considered in determining the dose and regimen of drug therapy in neonates. However, the research on the safety and efficacy of specific drugs is limited due to ethical and technical issues. This review article focuses on the neonatal pharmacokinetics and the rationales of drug therapy in neonates based on findings of previous studies and empirical evidence.
Absorption ; Bronchiolitis ; Drug Administration Routes ; Drug Therapy* ; Humans ; Infant ; Infant, Newborn* ; Infant, Premature ; Metabolism ; Pharmacokinetics* ; Population Characteristics

Interfacility transport of critically ill children (transport) is a challenging component of pediatric critical care. The risk associated with the transport may be reduced by a specialized pediatric transport team, a screening tool for critically ill children, and a standardized handover between referring and referred physicians. Further research is necessary in Korea regarding the above measures for the safe and effective transport.
Checklist ; Child* ; Critical Care ; Critical Illness* ; Humans ; Korea ; Mass Screening ; Pediatrics ; Transportation of Patients