BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

OBJECTIVE

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Pediatric patients aged 1 month to 18 years seen at the ED.

SETTING

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

MAIN OUTCOME MEASURES

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

MAIN RESULTS

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

CONCLUSION

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

Human ; Emergency Departments ; Emergency Service, Hospital ; Resuscitation ; Mortality

Objective To study the medical malpractice cases involving death, and discuss the identification ideas and methods of medical malpractice cases. Methods A total of 291 medical malpractice cases involving death accepted and settled from January 2012 to December 2017 at the Judicial Appraisal Center of Southern Medical University were collected. Based on the age, gender, hospital level, clinical department, whether or not autopsy was performed, cause of death, cause of medical mistakes, causality and causative potency of the appraised person, statistical analysis was made. Results There were more males than females in medical malpractice cases involving death. Mostly young adults or children were involved in these cases. The number of cases involving tertiary hospitals was the highest; among the clinical departments, the internal medicine department had the largest number of cases, followed by surgery, obstetrics and gynecology, pediatrics, etc. Autopsy rate has a trend of increasing year by year. Most patients die from the natural outcomes of their disease or ineffective treatment. Most hospitals have certain medical mistakes, and have an indirect correlation with the patient's death, mainly slight factors. Conclusion Judicial appraisal of medical malpractice should follow the principle of "one-effect and multi-cause", and comprehensively consider various factors such as, the diseases and constitution of the patient, natural outcomes of the diseases, the current medical technology and the level of diagnosis and treatment of the hospital, etc.
Autopsy ; Cause of Death ; Child ; Death ; Female ; Hospital Departments/statistics & numerical data* ; Humans ; Male ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Pregnancy ; Retrospective Studies ; Young Adult

BACKGROUND: Candidemia has increased with an increasing number of people in the high risk group and so has become more important. This study was conducted to investigate the isolation rate of Candida species from candidemia patients and the change in rate of antifungal resistance. METHODS: At a single tertiary care hospital, 1,120 blood cultures positive for Candida species from 1997 to 2016 were investigated according to date of culture, gender, age, and hospital department. RESULTS: During the investigation period, the number of candidemia patients increased from 14 in 1997 to 84 in 2016. The most common organism identified during the two decades was Candida albicans (40.8%), followed by Candida parapsilosis (24.1%), Candida tropicalis (13.2%), and Candida glabrata (12.8%). C. glabrata was relatively common in females (45.5%) compared to males. The age group 40-89 years was more frequently infected than other age groups, and the most frequent isolates according to age group were C. albicans in neonate (66.7%), C. parapsilosis in 1-9-year-olds (41.7%), and C. glabrata in those aged ≥60 years (range; 13.3%–20.0%). According to the visited departments, C. albicans, C. glabrata, and Candida haemulonii were more common in medical departments, while C. parapsilosis was more common in surgical departments. In the antifungal susceptibility test, a rising trend of azole resistance among C. albicans and C. glabrata was observed in recent years. CONCLUSION: In this study, it was confirmed that the isolation rate of Candida species in blood is different by age, gender, and hospital department, and the distribution of isolated Candida species changed over time. The resistance patterns of antifungal agents are also changing, and continuous monitoring and proper selection of antifungal agents are necessary.
Antifungal Agents ; Candida albicans ; Candida glabrata ; Candida tropicalis ; Candida* ; Candidemia* ; Danazol ; Drug Resistance, Fungal* ; Female ; Hospital Departments ; Humans ; Infant, Newborn ; Male ; Prevalence* ; Tertiary Healthcare*

PURPOSE: We investigated the impact of treatment on electroencephalogram (EEG) findings, and determined treatment efficacy according to EEG findings and antiepileptic drugs in children and adolescents with recurrent headaches. METHODS: We retrospectively analyzed the medical records of 131 patients, aged 5–18 years, with recurrent primary headaches and performed EEG study who visited the Chosun University Hospital Department of Pediatrics from January 2014 to December 2016. Headaches were classified according to the International Classification of Headache Disorders-III (ICHD-III, beta version), and EEGs were analyzed for changes after treatment for primary headache. RESULTS: Among 131 patients, we successfully collected completed all the data on 30 patients (18 boys, 12 girls). The frequency of abnormal EEG findings before treatment was not significantly different according to the type of primary headache (P= 0.390). The mean frequency (P=0.001), duration (P=0.002), and intensity of headaches (P < 0.001), and disability due to headache (P=0.003) were significantly decreased after treatment in patients with epileptiform discharges on EEG. The mean frequency and intensity of headaches and disability due to headache (P < 0.005) was also significantly decreased in the patients with both slow and normal EEG findings. The mean frequency (P=0.007), duration (P=0.01), and intensity (P < 0.001) of headaches, and disability due to headache (P=0.002) were significantly decreased after treatment with antiepileptic drugs in patients with epileptiform discharges. CONCLUSION: Abnormal EEG findings were no significant differences in terms of type of primary headaches. Our results suggest that antiepileptic drugs may alleviate headaches in patients with epileptiform discharges on EEG.
Adolescent* ; Anticonvulsants ; Child* ; Classification ; Electroencephalography* ; Headache* ; Hospital Departments ; Humans ; Medical Records ; Pediatrics ; Retrospective Studies ; Treatment Outcome

OBJECTIVES: To provide an initial overview of the outcomes of different treatment modalities used for hemangiomas.
METHODS:
Design: Case Series
Setting: Tertiary National University Hospital
Participants: Records of 21 patients diagnosed with head and neck hemangiomas in the Philippine General Hospital Department of Otorhinolaryngology from 2009 to 2014 were reviewed.
RESULTS: Majority of the patients were female (61.9%) and in the pediatric age group (57.1%). Of the 21 patients, 6 underwent medical management, 13 had surgical management, 1 had both medical and surgical management and 1 opted to observe the lesion. All patients treated with propranolol observed a decrease in the size of the lesion. Seven out of the 13 patients had radiofrequency ablation; all had gross residual lesion. Six of the 13 underwent excision with complete excision being achieved in 5 of 6 cases.
CONCLUSION: Treatment response of patients in this series with hemangiomas of the head and neck to propranolol at a dose of 1 to 2 mg/kg/day may reflect international data. Outcomes analysis for radiofrequency ablation and surgical excision requires a longer duration of follow-up.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Propranolol ; Hospitals, University ; Philippines ; Hemangioma ; Neck ; Head ; Hospital Departments ; Otolaryngology

The purpose of this study was to analyze the importance-performance of clinical nutrition management in convalescent hospitals. The research was carried out based on questionnaires administered from March to April, 2015 to 73 dietitians at 40 convalescent hospitals in the Gyeongnam area. There was a statistically significant difference between the mean scores for importance (4.01/5.00) and performance (2.95/5.00) of clinical nutrition management. The importance and performance grid analysis showed that participation in a nutritional management committee, administration of patients using a cooperation program among hospital departments, cooperation with a medical team on patient's nutrition status, nutrition initial assessment, nutrition care process for patients showing malnutrition, nutrition care process for tube feeding patients, management of a therapeutic diet, meal management using dietary slip instructions including a therapeutic diet, and explication of a therapeutic diet for patients scored high regarding importance and performance (doing great area). Medical records on patient's nutrition management, and nutrition counseling for requested patient scored low regarding the importance and high regarding performance (overdone area). Participation in medical rounds, personal nutrition education for patients, group nutrition education for patients, nutrition education for medical teams, development of a menu for therapeutic diet and standardized recipes, and provision of information on diet therapy for patients after discharge scored low regarding importance and performance (low priority area). Accreditation of convalescent hospitals and interest of medical professionals in clinical nutrition management were effective variables for the importance-performance gap of clinical nutrition management. In conclusion, the accreditation process and positive awareness of medical professionals with regard to clinical nutrition management had positive effects on reduction of the importance-performance gap in clinical nutrition management at convalescent hospitals. The strength of clinical nutrition management in the accreditation and development of an education program for increasing medical team or administrator interest in clinical nutrition management could lead to improvement of clinical nutrition management for elderly patients in convalescent hospitals.
Accreditation ; Administrative Personnel ; Aged ; Counseling ; Diet ; Diet Therapy ; Education ; Enteral Nutrition ; Hospital Departments ; Hospitals, Convalescent* ; Humans ; Malnutrition ; Meals ; Medical Records ; Nutrition Assessment ; Nutritional Status ; Nutritionists

As the largest research-oriented specialty department in national traditional Chinese medicine hospitals, the Department of Critical Care Medicine in Guangdong Provincial Hospital of Chinese Medicine insists on the development mode combined with clinical medicine and scientific research. By taking clinical and basic researches for integrative medicine preventing and treating acute myocardial in-farction and sepsis as a breakthrough, authors explored key problems of Chinese medicine in improving the prognosis related diseases and patients' quality of life. In recent 3 years our department has successively become the principal unit of the national key specialties cooperative group of critical care medicine (awarded by State Administration of Traditional Chinese Medicine), the key clinical specialties (awarded by National Health and Family Planning Commission), and Guangzhou key laboratory construction unit, and achieved overall lap in clinical medical treatment, personnel training, scientific research, and social service.
Biomedical Research ; China ; Clinical Medicine ; Critical Care ; Hospital Departments ; organization & administration ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; Quality of Life

BACKGROUND: Organizational changes that involve healthcare hospital departments and care services of health districts, and ongoing technological innovations and developments in society increasingly expose healthcare workers (HCWs) to work-related stress (WRS). Minimizing occupational exposure to stress requires effective risk stress assessment and management programs. METHODS: The authors conducted an integrated analysis of stress sentinel indicators, an integrated analysis of objective stress factors of occupational context and content areas, and an integrated analysis between nurses and physicians of hospital departments and care services of health districts in accordance with a multidimensional validated tool developed in Italy by the National Network for the Prevention of Work-Related Psychosocial Disorders. The purpose of this retrospective observational study was to detect and analyze in different work settings the level of WRS resulting from organizational changes implemented by hospital healthcare departments and care services of health districts in a sample of their employees. RESULTS: The findings of the study showed that hospital HCWs seemed to incur a medium level risk of WRS that was principally the result of work context factors. The implementation of improvement interventions focused on team development, safety training programs, and adopting an ethics code for HCWs, and it effectively and significantly reduced the level of WRS risk in the workplace. CONCLUSION: In this study HCW resulted to be exposed to occupational stress factors susceptible to reduction. Stress management programs aimed to improve work context factors associated with occupational stress are required to minimize the impact of WRS on workers.
Codes of Ethics ; Delivery of Health Care* ; Education ; Hospital Departments ; Inventions ; Italy* ; Observational Study ; Occupational Exposure ; Organizational Innovation ; Retrospective Studies

PURPOSE: This study was done to determine inpatient fall rates in an acute hospital setting and to explore risk factors and characteristics across clinical departments. METHODS: The medical records and standardized fall reports of 416 patients admitted between January 1 and December 31, 2012 were reviewed. Descriptive statistics and statistical tests were used, including: t-test, chi2-test, ANOVA. RESULTS: The total fall rate per 1,000 inpatient days was 0.49. Fall rate, fall risk factors and characteristics such as age, type of fallers and mean MFS (Morse Fall Scale) differed significantly among clinical departments. CONCLUSIONS: The analysis results show that the fall rates, fall risk factors and characteristics of acute hospital inpatient falls varied significantly across clinical departments. The findings of this study suggest that hospitals should consider differences in fall related characteristics across clinical departments when implementation fall prevention strategies and interventions.
Accidental Falls ; Hospital Departments ; Humans ; Inpatients ; Medical Records ; Risk Factors*

OBJECTIVETo investigate the incidence, pathogens, and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital.

METHODThe incidence, pathogen, treatment, and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed.

RESULTSThere were 449 positive samples (5.8%) from 4 890 patients during this period, among which 388 were proved to be with pathogenic bacteria. Samples separated from patients with community-aquired infections accounted for 8.4% of all positive samples. Most community-aquired infections were caused by Gram-negative bacteria (75%), although no multidrug-resistant bacteria was observed. Samples separated from patients with nosocomial infections accounted for 91.6% of all positive samples. Respiratory tract (49.4%) and peripheral blood (32.6%) were the most common samples with positive results. Skin soft tissues (10.4%), and urine (3.7%) were less common samples. Most of the pathogenic bacteria of the nosocomial infections were Gram-negative (66.9%). The most common Gram-negative bacteria included Escherichia coli (13.8%), Pseudomonas aeruginosa (12.1%), and Klebsiella pneumonia (12.1%), while Staphylococcus aureus (10.4%), Enterococcus faecium (7.0%), and Staphylococcus epidermidis (5.1%) were the most common Gram-positive bacteria. Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples. Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria (63.8%). The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca, Escherichia coli, and Proteus mirabilis were 24.0%, 87.9% and 38.4%, respectively. The resistance to Acinetobacter baumannii was serious. Multidrug-resistant, extensive drug resistant and pan drug resistant A. baumannii acountted for 74% of all A. Baumannii infections. Stenotrophomonas maltophilia showed low resistance to sulfamethoxazole/trimethoprim, levofloxacin and minocycline. Also, 22 methicillin-resistant Staphylococcus aureus and 9 methicillin-resistant Staphylococcus Epidermidis were detected, which were only sensitive to vancomycin, teicoplanin, and linezolid. All patients were treated in the haematology wards and most of them were under agranulocytosis or immunosuppression. Finally, 22 patients reached clinical recovery through anti-infective therapy, whereas 49 patients died. Among those deaths, 42 patients attributed to severe infections and infection-associated complications. Fourteen of all the deaths might be infected with drug-resistance bacteria. There were 61 samples proved to be bacteria colonization. Nonfermenters such as Acinetobacter baumannii and Stenotrophomonas maltophilia made up for a large amount of bacteria colonization.

CONCLUSIONSThe pathogens of nosocomial infections in the hematology ward are mainly Gram-negative bacteria. The incidences and pathogens vary from different infection sites. Nosocomial infection still has a higher mortality rate. Once nonfermenters are detected positive, the pathogenic or colonial bacteria should be distinguished.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteria ; isolation & purification ; Bone Marrow Transplantation ; Cross Infection ; microbiology ; Female ; Hematologic Diseases ; complications ; microbiology ; Hematology ; Hospital Departments ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult