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*

Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Pandemics ; Patient Acceptance of Health Care/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology*

BACKGROUND: The Rugby World Cup (RWC) is one of the biggest international mega sports events in the world. This study was conducted to identify and evaluate the volume, nature, and severity of spectator medical care in the stadiums of 12 venues across Japan during RWC 2019. METHOD: This was a retrospective review of medical records from spectator medical rooms of 45 official matches of RWC 2019 between September 20 and November 2, 2019. All patients in the stadium who visited the spectator medical room and were transferred to a hospital were included. The wet bulb globe temperature (WBGT) value at the kick-off time of each match, the number of visits to the spectator medical room, and the number of transfers to a hospital were reviewed and analyzed. The patient presentation rate (PPR) was calculated per 10,000 attendees. Severity categories were defined as mild or severe. Mild cases were considered non-life threatening requiring minimal medical intervention, and severe cases required transport to a hospital. RESULT: The total number of visits to the spectator medical room was 449 with a PPR of 2.63. Most cases (91.5%) were mild in severity. The PPR was significantly higher for the matches held with a WBGT over 25 °C than for the matches under 21 °C (PPR 4.27 vs 2.04, p = 0.04). Thirty-eight cases were transferred to a hospital by ambulance; the PPR was 0.22. The most common reasons for transfer to the hospital were heat illness and fracture/dislocation, at a rate of 15.8% each. The incidence rate of cardiopulmonary arrest per 10,000 attendees was 0.0059 during RWC 2019. CONCLUSION Preparation and provision of appropriate medical service for spectators is a key factor for mass-gathering events. During RWC 2019, the majority (91.5%) of patients who sought medical attention did so for minor complaints, which were easily assessed and managed. On the other hand, a higher WBGT situation contributes significantly to an increased PPR (< 21 versus > 25, 2.04 versus 4.27, p = 0.04). Careful medical preparation, management, and development of public education programs for higher WBGT situations will be required in the future for similar international mega sports events.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Care/statistics & numerical data* ; Anniversaries and Special Events ; Child ; Child, Preschool ; Emergency Service, Hospital/statistics & numerical data* ; Female ; Football ; Hospitalization/statistics & numerical data* ; Humans ; Infant ; Infant, Newborn ; Japan ; Male ; Mass Behavior ; Middle Aged ; Retrospective Studies ; Young Adult

PURPOSE: To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster. METHODS: A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated. RESULTS: Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure. CONCLUSION In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.
Adolescent ; Adult ; Child ; Cyclonic Storms ; Disaster Planning ; Disaster Victims ; statistics & numerical data ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; epidemiology ; etiology ; Retrospective Studies ; Tertiary Care Centers ; Trauma Centers ; Trauma Severity Indices ; Young Adult

BACKGROUND: Understanding the epidemiology of anaphylaxis is imperative for appropriate diagnosis and treatment, but the prevalence reportedly varies and only a few studies have compared the clinical features of anaphylaxis with the underlying causes in Korea. OBJECTIVE: This study aimed to investigate the etiology and clinical features of anaphylaxis. METHODS: We retrospectively reviewed the medical records of 319 anaphylaxis patients who visited our emergency room and extracted information on the causes, clinical characteristics, and subsequent outpatient visits. RESULTS: Food, drugs, and environmental factors were common causes of anaphylaxis. Statistically significant differences (p<0.001) were observed between children (<18 years of age) and adults (≥18 years of age), with food and drugs identified as the most common causes, respectively. Clinical characteristics of the patients were compared according to the common causes of anaphylaxis. Cutaneous symptoms were observed more frequently in food-induced cases (n=137, 95.1%) compared to drug-induced (n=73, 77.7%) and bee sting-induced (n=18, 78.3%) cases (p<0.001), whereas neurological symptoms were observed more frequently in drug-induced (n=37, 39.4%) and bee sting-induced (n=11, 47.8%) cases than in food-induced (n=18, 12.5%) cases (p<0.01). Drug-induced (n=44, 46.8%) and bee sting-induced (n=11, 47.8%) cases were more severe than food-induced cases (n=32, 22.2%). Out of the 319 assessed patients, only 25, 14, and 14 patients were referred to the pediatrics, allergy, and dermatology departments, respectively, after visiting the emergency room. CONCLUSION: Clinical characteristics of anaphylactic patients differed according to the underlying cause, but these findings are presumably influenced by factors determining the severity of anaphylaxis. We found that subsequent follow-up care in other departments to identify the cause of anaphylaxis was inadequate for most patients.
Adult ; Anaphylaxis ; Bees ; Child ; Dermatology ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Follow-Up Studies ; Humans ; Hypersensitivity ; Korea ; Medical Records ; Outpatients ; Pediatrics ; Prevalence ; Retrospective Studies ; Tertiary Care Centers

PURPOSE: The purpose of this study was to examine the frequency, perceived importance and competence of pediatric emergency nursing practice (PENP) in nurses who cared for pediatric patients in the emergency department. METHODS: This cross-sectional descriptive study analyzed 175 emergency department nurses caring for pediatric patients at 7 university hospitals with more than 500 beds, located in Seoul and Gyeonggi Province. The measurement tool was modified from the Classification of Standard Nursing Activities to measure the frequency, importance of PENP, and nursing competence. It comprised 143 items in 16 domains of PENP. RESULTS: The most frequent nursing practice was the domain of ‘nursing records and environmental management’ and the least frequent practice was the ‘research and consulting’ domain. The nursing care domain perceived to be most important by nurses was ‘specialized intensive nursing care’. The nursing care domain with the highest level of nursing competence was ‘hygiene care’, and the domain with the least level of nursing competence was the ‘research and consulting’. CONCLUSION: These results will be utilized as basic data for future pediatric emergency nursing education initiatives and for establishing priorities of nursing policy to improve health care for children admitted to the emergency department.
Child ; Child Care ; Classification ; Delivery of Health Care ; Education ; Emergencies ; Emergency Nursing ; Emergency Service, Hospital ; Gyeonggi-do ; Hospitals, University ; Humans ; Mental Competency ; Nurse's Role ; Nursing Care ; Nursing ; Professional Competence ; Seoul

PURPOSE: Epilepsy is the most common neurological disorder in childhood. Hospital nurses, who are the first to recognize seizures in epilepsy patients in the ward environment, possess expertise related to epilepsy and play a central role in epilepsy management. The purpose of this study was to develop an algorithm-based education program and to improve nurses' knowledge and self-efficacy related to providing nursing care to children with epilepsy. METHODS: The education program consisted of lectures on the definition, cause, classification, diagnosis, treatment, and nursing of epilepsy based on a booklet, as well as practice using an algorithm for nursing interventions when a child experiences a seizure. Twenty-seven nurses working at pediatric neurological wards and a pediatric emergency room participated in the education program. The data were analyzed using descriptive statistics and the paired t-test. RESULTS: Nurses' knowledge and self-efficacy showed a statistically significant improvement after participation in the education program on nursing care for children with epilepsy. CONCLUSION: The application of this education program for hospital setting is expected to improve nurses' capability to care for children with epilepsy, thereby contributing to a higher quality of nursing.
Child ; Classification ; Diagnosis ; Education ; Education, Nursing ; Emergency Service, Hospital ; Epilepsy ; Humans ; Lectures ; Nervous System Diseases ; Nursing Care ; Nursing ; Pamphlets ; Seizures

PURPOSE: To study the performance of the combined models of Pediatric Risk of Admission (PRISA) scores I and II and Creactive protein (CRP) for prediction of hospitalization in febrile children who visited the emergency department.METHODS: We reviewed febrile children aged 4 months-17 years who visited a tertiary hospital emergency department between January and December 2017. White blood cell count, CRP concentration, the PRISA scores, and systemic inflammatory response syndrome score were calculated. We compared areas under the curves (AUCs) of the admission decision support tools for hospitalization using receiver operating characteristic curve analysis.RESULTS: Of 1,032 enrolled children, 423 (41.0%) were hospitalized. CRP and the PRISA scores were significantly higher in the hospitalization group than in the discharge group (all P < 0.001). Among the individual tools, CRP showed the highest AUC (0.69; 95% confidence interval [CI], 0.66–0.72). AUC was 0.71 (95% CI, 0.69–0.74) for the combined model of the PRISA I score and CRP, and 0.71 (95% CI, 0.68–0.74) for that of the PRISA II score and CRP. The AUC of PRISA score I and CRP combined was significantly higher than that of isolated CRP (P = 0.048).CONCLUSION: The combined model of the PRISA I score and CRP may be useful in predicting hospitalization of febrile children in emergency departments.
Area Under Curve ; C-Reactive Protein ; Child ; Decision Support Techniques ; Emergencies ; Emergency Service, Hospital ; Fever ; Hospitalization ; Humans ; Leukocyte Count ; Patient Admission ; ROC Curve ; Systemic Inflammatory Response Syndrome ; Tertiary Care Centers

PURPOSE: This study was conducted to design services for improving the quality of care of hospitalized children with acute diseases.METHODS: The service design process had four phases: discovery, definition, development, and delivery. The participants were 23 mothers of hospitalized children with an acute disease, and seven nurses and three doctors working at a pediatric hospital. Data were collected through self-report questionnaires, in-depth interviews, and observations. The data were analyzed using content analysis and descriptive statistics.RESULTS: The participants reported needs for explanations about the treatment, skillful nursing, and environmental improvements. The concept of the services was familiarity and enjoyment, aimed at solving the problems of unfamiliarity and boredom. A six-guideline was presented for improving the quality of care of hospitalized children with acute diseases: improvement of awareness, development of educational materials, improvement of skills, environmental improvements, play activities, and evaluations of user satisfaction.CONCLUSION: These findings indicate that nursing services should deliver familiarity and enjoyment to hospitalized children and their families. The findings of this study emphasize that the service design methodology can be used to improve the quality of care of hospitalized children with acute diseases.
Acute Disease ; Boredom ; Child ; Child, Hospitalized ; Hospitals, Pediatric ; Humans ; Mothers ; Nursing ; Nursing Service, Hospital ; Nursing Services ; Quality of Health Care ; Recognition (Psychology)

OBJECTIVE: The practice of allowing parental presence during invasive procedures in children varies depending on setting and individual provider preference. We aim to understand the attitudes, preferences, and practices of physicians and nurses with regard to parental presence during invasive pediatric emergency procedures in an Asian cultural context.METHODS: We surveyed physicians and nurses in the pediatric emergency department of a large tertiary hospital using separate self-administered questionnaires over three months. The data collected included the demographics and clinical experience of interview respondents. Each provider was asked about their attitude and preference regarding parental presence during specific invasive procedures.RESULTS: We surveyed 90 physicians and 107 nurses. Most physicians in our context preferred to perform pediatric emergency procedures without parental presence (82, 91.1%). Forty physicians (44.4%) reported that parental presence slowed down procedures, while 75 (83.3%) felt it increased provider stress. Most physicians made the decision to allow parents into the procedure room based on parental attitude (69, 76.7%) and the child's level of cooperation (64, 71.1%). Most nurses concurred that parental presence would add to provider stress during procedures (69, 64.5%). We did not find a significant relationship between provider experience (P=0.26) or age (P=0.50) and preference for parental presence.CONCLUSION: In our cultural context, most physicians and nurses prefer to perform procedures for children in the absence of parents. We propose that this can be changed by health professional training with role play and simulation, adequate supervision by experienced physicians, and clear communication with parents.
Asia ; Asian Continental Ancestry Group ; Child ; Demography ; Emergencies ; Emergency Service, Hospital ; Health Occupations ; Humans ; Organization and Administration ; Parents ; Surveys and Questionnaires ; Tertiary Care Centers