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A case of Herlyn-Werner-Wunderlich syndrome: a rare, congenital genitourinary anomaly in a 12-year-old girl.

Pediatric Emergency Medicine Journal.2016;3(1):32-35.

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

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Epidemiologic characteristics of children who visited an emergency department: a single center study over three years.

Suyeol CHOI ; Insoo CHO ; Chulmin HA

Pediatric Emergency Medicine Journal.2016;3(1):24-31.

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

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Point-of-care ultrasound may reduce emergency department length of stay in children with nonspecific manifestations of intussusception.

Sung Min HAN ; Jung Heon KIM ; Jong Seung LEE

Pediatric Emergency Medicine Journal.2016;3(1):15-23.

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

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Methods of weight estimation in pediatric resuscitation.

Jae Yun JUNG ; Hyuksool KWON ; Yoo Jin CHOI

Pediatric Emergency Medicine Journal.2016;3(1):9-14.

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*

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Non-emergency department models for pediatric after-hours care.

Mi Jin KIM

Pediatric Emergency Medicine Journal.2016;3(1):1-8.

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

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Prehospital transport of critically ill children via 119 emergency medical service providers: problems and improvement plan.

Hyun NOH

Pediatric Emergency Medicine Journal.2017;4(2):34-37. doi:10.22470/pemj.2017.00171

The number of critically ill children visiting the emergency department has increased. However, the rate of transporting critically ill children via 119 emergency medical service providers ranges from 4.5% to 17.5%, and the prehospital care is insufficient. To improve the transport, first, it is necessary to expand the prehospital care equipment for critically ill children. Second, 119 personnel should be trained regularly with a revised protocol for the prehospital care. Third, the appropriateness of the prehospital care should be evaluated.
Child* ; Critical Illness* ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital ; Humans ; Pediatrics ; Transportation

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Strengthening the role of pediatric emergency centers in Korea.

Jin Hee JUNG ; Young Ho KWAK ; Hyun NOH

Pediatric Emergency Medicine Journal.2017;4(2):29-33. doi:10.22470/pemj.2017.00178

Since 2016, the pediatric emergency centers (PECs) have been selected by the Korean Ministry of Health and Welfare, but there are still many problems in their designation and operation. The authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, sought to identify the current status and plans for improvement of PECs in Korea. The problems in the designation and operation are the disproportionate regional distribution of the PECs, financial difficulties in meeting the designation criteria, and recruitment of dedicated pediatric emergency specialists. To improve this, it is necessary to designate additional PECs and analyze the appropriateness of insurance cost, to strengthen the role other than the community practice, and to reinforce back-up treatment by pediatric sub-specialists in PECs.
Community Health Services ; Emergencies* ; Emergency Medicine ; Financial Support ; Geography, Medical ; Insurance ; Korea* ; Local Government ; Personnel Selection ; Specialization

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Prehospital transport of critically ill children via 119 emergency medical service providers: problems and improvement plan.

Hyun NOH

Pediatric Emergency Medicine Journal.2017;4(2):34-37. doi:10.22470/pemj.2017.00171

The number of critically ill children visiting the emergency department has increased. However, the rate of transporting critically ill children via 119 emergency medical service providers ranges from 4.5% to 17.5%, and the prehospital care is insufficient. To improve the transport, first, it is necessary to expand the prehospital care equipment for critically ill children. Second, 119 personnel should be trained regularly with a revised protocol for the prehospital care. Third, the appropriateness of the prehospital care should be evaluated.
Child* ; Critical Illness* ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital ; Humans ; Pediatrics ; Transportation

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Strengthening the role of pediatric emergency centers in Korea.

Jin Hee JUNG ; Young Ho KWAK ; Hyun NOH

Pediatric Emergency Medicine Journal.2017;4(2):29-33. doi:10.22470/pemj.2017.00178

Since 2016, the pediatric emergency centers (PECs) have been selected by the Korean Ministry of Health and Welfare, but there are still many problems in their designation and operation. The authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, sought to identify the current status and plans for improvement of PECs in Korea. The problems in the designation and operation are the disproportionate regional distribution of the PECs, financial difficulties in meeting the designation criteria, and recruitment of dedicated pediatric emergency specialists. To improve this, it is necessary to designate additional PECs and analyze the appropriateness of insurance cost, to strengthen the role other than the community practice, and to reinforce back-up treatment by pediatric sub-specialists in PECs.
Community Health Services ; Emergencies* ; Emergency Medicine ; Financial Support ; Geography, Medical ; Insurance ; Korea* ; Local Government ; Personnel Selection ; Specialization

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The diagnosis of Kawasaki disease in a 10-year-old girl presenting with cervical lymphadenopathy and fever suggesting retropharyngeal abscess.

Soyun HWANG ; Jea Yeon CHOI

Pediatric Emergency Medicine Journal.2017;4(2):102-105. doi:10.22470/pemj.2017.00115

Given that Kawasaki disease (KD) can cause cardiac complications, it is crucial to diagnose and treat the disease in the emergency department. We report a case of a 10-year-old girl who presented to the emergency department with cervical lymphadenopathy and fever. The initial diagnosis was retropharyngeal abscess based on computed tomography findings, but antibiotic therapy failed and she was subsequently diagnosed with KD. After 3 doses of intravenous immunoglobulin along with methylprednisolone and methotrexate, she was discharged on hospital day 21. The cervical lymphadenopathy suggesting retropharyngeal abscess might be an early sign of incomplete or intravenous immunoglobulin-resistant KD.
Child* ; Diagnosis* ; Emergency Service, Hospital ; Female* ; Fever* ; Humans ; Immunoglobulins ; Lymphatic Diseases* ; Methotrexate ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Neck Pain ; Retropharyngeal Abscess* ; Vasculitis

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