INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; Singapore/epidemiology*

PURPOSE: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. METHODS: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, χ² test, t-test, and logistic regression analyses. RESULTS: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (χ²=14.10, p=.007), admission type (χ²=7.40, p=.007), use of physical restraints (χ²=26.11, p<.001), RASS score (χ²=14.80, p=.001), need for oxygen (χ²=5.31, p=.021), use of a mechanical device (χ²=9.97, p=.041), feeding (χ²=7.85, p=.005), and the presence of familiar objects (χ²=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). CONCLUSION: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
Caregivers ; Child ; Critical Care ; Delirium ; Diagnosis ; Dihydroergotamine ; Humans ; Incidence ; Infant, Newborn ; Intensive Care Units ; Logistic Models ; Oxygen ; Pediatrics ; Restraint, Physical ; Risk Factors ; Statistics as Topic

INTRODUCTIONThis study aimed to determine the usefulness and validity of the triaging scale used in our emergency department (ED) by analysing its association with surrogate clinical outcome measures of severity consisting of hospitalisation rate, intensive care unit (ICU) admission, length of ED stay, predictive value for admission and length of hospitalisation.

METHODSA retrospective observational study was conducted of the performance markers of the Singapore Paediatric Triage Scale (SPTS) to identify children who needed immediate and greater care. All children triaged and attended to at the paediatric ED at KK Women's and Children's Hospital, Singapore, from 1 January 2014 to 31 December 2014 were included. Data was retrieved from the Online Paediatric Emergency Care system, which is used for patients' care from initial triaging to final disposition.

RESULTSAmong 172,933 ED attendances, acuity levels 1, 2 plus, 2 and 3 were seen in 2.3%, 26.4%, 13.5% and 57.8% of patients, respectively. For admissions, triage acuity level 1 had a strong positive predictive value (79.5%), while triage acuity level 3 had a strong negative predictive value (93.7%). Fewer patients with triage acuity level 3 (6.3%) were admitted as compared to those with triage acuity level 1 (79.5%) (p < 0.001). There was a correlation between triage level and length of ED stay.

CONCLUSIONThe SPTS is a valid tool for use in the paediatric emergency setting. This was supported by strong performance in important patient outcomes, such as admission to hospital, ICU admissions and length of ED stay.

Child ; Child, Preschool ; Critical Care ; statistics & numerical data ; Emergency Service, Hospital ; Female ; Hospitalization ; Hospitals, Pediatric ; Humans ; Infant ; Intensive Care Units ; Length of Stay ; Male ; Patient Admission ; Pediatrics ; methods ; Predictive Value of Tests ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome ; Triage ; methods

: One of the most feared complications of childhood cancer treatment is second malignant neoplasms (SMNs). This study evaluates the incidence, risk factors and outcomes of SMNs in a tertiary paediatric oncology centre in Singapore.: A retrospective review was conducted on patients diagnosed with childhood cancer under age 21 and treated at the National University Hospital, Singapore, from January 1990 to 15 April 2012. Case records of patients with SMNs were reviewed.: We identified 1124 cases of childhood cancers with a median follow-up of 3.49 (0 to 24.06) years. The most common primary malignancies were leukaemia (47.1%), central nervous system tumours (11.7%) and lymphoma (9.8%). Fifteen cases developed SMNs, most commonly acute myeloid leukaemia/myelodysplastic syndrome (n = 7). Median interval between the first and second malignancy was 3.41 (0.24 to 18.30) years. Overall 20-year cumulative incidence of SMNs was 5.3% (95% CI, 0.2% to 10.4%). The 15-year cumulative incidence of SMNs following acute lymphoblastic leukaemia was 4.4% (95% CI, 0% to 8.9%), significantly lower than the risk after osteosarcoma of 14.2% (95% CI, 0.7% to 27.7%) within 5 years (<0.0005). Overall 5-year survival for SMNs was lower than that of primary malignancies.: This study identified factors explaining the epidemiology of SMNs described, and found topoisomerase II inhibitor use to be a likely risk factor in our cohort. Modifications have already been made to our existing therapeutic protocols in osteosarcoma treatment. We also recognised the importance of other risk management strategies, including regular long-term surveillance and early intervention for detected SMNs, to improve outcomes of high risk patients.
Bone Neoplasms ; therapy ; Cancer Care Facilities ; Central Nervous System Neoplasms ; therapy ; Follow-Up Studies ; Humans ; Incidence ; Leukemia ; therapy ; Leukemia, Myeloid, Acute ; epidemiology ; Lymphoma ; therapy ; Myelodysplastic Syndromes ; epidemiology ; Neoplasms ; therapy ; Neoplasms, Second Primary ; epidemiology ; Osteosarcoma ; therapy ; Pediatrics ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survivors ; statistics & numerical data ; Tertiary Care Centers ; Time Factors ; Topoisomerase II Inhibitors ; therapeutic use

PURPOSEThe epidemiology of pediatric trauma is different in different parts of the world. Some re- searchers suggest falls as the most common mechanism, whereas others report road traffic accidents (RTAs) as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India.

METHODSInpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21.

RESULTSWe had 300 patients over a 33 month period. Among them, 236 (78.6%) were males and 64 (21.3%) females. Overall the predominant cause was RTAs in 132 (43%) patients. On subgroup analysis of up to 12 years age group (n = 147), the most common cause was found to be RTAs again. However, falls showed an incremental upward trend (36.05% in up to 12 age group versus 27% overall), catching up with RTAs (44.89%). Pediatric Trauma Score (PTS) ranged from 0 to 12 with a mean of 8.12 ± 2.022. 223 (74.33%) patients experienced trauma limited to one anatomic region only, whereas 77 (25.66%) patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days (range 1-182).

CONCLUSIONPediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs (43%) as compared to falls from height (27%); however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns must be taken into account when formulating policies to address this unique challenge.

Accidental Falls ; mortality ; statistics & numerical data ; Accidents, Traffic ; mortality ; statistics & numerical data ; Adolescent ; Child ; Child, Preschool ; Databases, Factual ; Developing Countries ; Female ; Humans ; Incidence ; India ; Injury Severity Score ; Length of Stay ; Male ; Pediatrics ; Registries ; Risk Assessment ; Survival Rate ; Trauma Centers ; Wounds and Injuries ; diagnosis ; epidemiology ; surgery

OBJECTIVETo explore the status of articles published in Chinese Journal of Pediatrics from 2005 to 2014.

METHODAll the articles published in Chinese Journal of Pediatrics from 2005 to 2014 were searched at Wanfang Medical Online database. The total number and citations of articles, authors, agency, single article citation, internet downloads, columns, fund and Mesh were analyzed. The end of searching period was January 2015.

RESULTFrom 2005 to 2014, 2814 articles were published in Chinese Journal of Pediatrics, 235 to 380 articles per year. A total of 1 596 articles were cited, the citation rate was 56.16%, total number of citation was 15 428. Among single article citations, of the top 20 articles, 55% (11/20) were those published in the Standard/Protocol/Guide column. Of the top 20 papers most frequently downloaded on internet, 100% were articles published in the Standard/Protocol/Guide column. During the recent 10 years, the source of the papers published in the journal covered 31 provinces, municipalities and autonomous regions. The column that published the largest number of articles was Original Article (911, 32.05%), followed by Case Report (336,11.82%) and Review (245, 8.62%). Of the total number of articles published in the journal, 747 were supported by fund, which accounted for 26%. The articles supported by national fund accounted for 8%.

CONCLUSIONArticles published in Chinese Journal of Pediatrics had high-quality and can reflect the development and research progress in pediatric medicine. It is one of the most important information resources in pediatric academic fields in China.

Bibliometrics ; China ; Pediatrics ; Periodicals as Topic ; statistics & numerical data

Child ; China ; Humans ; Pediatrics ; Periodicals as Topic ; standards ; statistics & numerical data ; Publishing ; standards ; statistics & numerical data ; Quality Control

OBJECTIVETo explore academic significance and guiding function played by subspecialty groups of the Society of Pediatrics, Chinese Medical Association on Chinese pediatric clinical practice through a statistical analysis of the articles published by the subspecialty groups.

METHODBibliometric methods were used to analyze the number of articles, article types, total citations, highly cited articles and the distribution of citing journals.

RESULTTotally 7 156 articles were published in Chinese Journal of Pediatrics from 1993 (31) to 2012 (51), of which 187 by subspecialty groups of pediatrics (2.6%), with a total citations of 11 985. Among them, 137 articles were cited with a citation rate of 73.3% and average citations for each article was 64.1. Articles classified as clinical guidelines had been totally cited for 10 900 times with average citations of 123.86 per article. The article on Neonatal hypoxic ischemic encephalopathy diagnosis and clinical index was cited 1 791 times ranked in highly cited literatures. All the top three cited literature periodicals were core journals of pediatrics, and 10 periodicals among the top 20 were in pediatrics and the rest in other medical fields.

CONCLUSIONThe number of the articles published by the subspecialty groups of pediatrics was increasing year by year though the portion it in the total number of the articles in the journal was not large. However, the citation frequency of the articles by the subspecialty groups of pediatrics was high, making an obvious contribution to the total citations of Chinese Journal of Pediatrics. The total citation rate of clinical guideline articles and their average rate was higher than those of other articles published in this journal, which meant that this type of articles provided academic references with guiding significance for clinical practice of pediatrics and for other medical fields as well.

Bibliometrics ; China ; Pediatrics ; Periodicals as Topic ; standards ; statistics & numerical data ; Publishing ; statistics & numerical data ; Review Literature as Topic

OBJECTIVEDevelopment and use of better medicine for children is a worldwide problem recently, especially in China. The current situation of drugs for children's renal diseases is far from well-understood now. This survey focused on drugs for pediatric renal diseases including immunosuppressants, corticosteroids, diuretics, anticoagulants, hypotensives and antilipemic agents.Information regarding the dosage, form, precaution, usage and administration in inserts was collected in this study.

METHODDrugs for pediatric renal diseases were selected according to the guidelines established by the Chinese Society of Pediatric Nephrology. The detailed information about the dosage, form of drugs was searched on the website of China-State Food and Drug (SFDA). The information of the precaution, usage and administration was obtained from the China Pharmaceutical Reference, the first edition.

RESULTIn this study, there were 5 categories of medicine including immunosuppressants, corticosteroids, diuretics, anticoagulants, hypotensives and antilipemic agents, and 89 kinds of medicine for renal diseases. Among these medicines, 65.2% were found not suitable for children in terms of drug dosage and form, 19.1% did not indicate the precaution, 51.7% did not indicate clearly the safety and effectiveness for children, and 56.2% lacked the detailed information about the usage and administration for children. There were only 4 kinds of these medicines which were studied via clinical trials in children population.

CONCLUSIONThere is a lack of drugs for children with renal diseases. Most of the time, the medicines used by doctors are not specially manufactured for children. The safety and efficacy of drugs that are currently used to treat pediatric renal diseases are not clear and definite.In addition, few clinical trials have been conducted for evaluation of drugs for pediatric renal diseases.In clinic, the situation of off-label drug treatment is very serious.

Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; China ; Diuretics ; administration & dosage ; therapeutic use ; Dosage Forms ; Drug Approval ; Drug Labeling ; Drug Therapy ; standards ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Infant ; Kidney Diseases ; drug therapy ; Medication Therapy Management ; statistics & numerical data ; Off-Label Use ; statistics & numerical data ; Pediatrics

INTRODUCTIONThis study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore.

METHODSData pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter.

RESULTSA total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children.

CONCLUSIONCritical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

Adolescent ; Adult ; Anesthesia ; adverse effects ; methods ; Anesthesiology ; methods ; Child ; Child, Preschool ; Hospitals, Teaching ; Humans ; Infant ; Infant, Newborn ; Medical Errors ; prevention & control ; statistics & numerical data ; Pediatrics ; methods ; Quality Assurance, Health Care ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult