Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality.
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ABSTRACT:
SUBMITTER: Giri S
PROVIDER: S-EPMC7502999 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
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Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality.
Giri Samita S Halvas-Svendsen Tine T Rogne Tormod T Shrestha Sanu Krishna SK Døllner Henrik H Solligård Erik E Risnes Kari K
Global pediatric health 20200918
<i>Background.</i> In low-income countries, pediatric emergency care is largely underdeveloped although child mortality in emergency care is more than twice that of adults, and mortality after discharge is high. <i>Aim.</i> We aimed at describing characteristics, triage categories, and post-discharge mortality in a pediatric emergency population in Nepal. <i>Methods.</i> We prospectively assessed characteristics and triage categories of pediatric patients who entered the emergency department (ED ...[more]
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Project description:BackgroundThere is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan.MethodsIn this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants' chief complaints and medical care were documented. Patients were followed-up at 48-h and 14-days via telephone.ResultsOf 3115 participants, 1846 were triaged to the outpatient department and 1269 to the ED. Patients triaged to the ED had a median age of 2.0 years (IQR 0.5-4.0); 30% were neonates (< 28 days). Top chief complaints were fever (45.5%), diarrhea/vomiting (32.3%), respiratory (23.1%), abdominal (7.5%), and otolaryngological problems (5.8%). Temperature, pulse and respiratory rate, and blood glucose were documented for 66, 42, and 1.5% of patients, respectively. Interventions included medications (92%), IV fluids (83%), oxygen (35%), and advanced airway management (5%). Forty-five percent of patients were admitted; 11 % left against medical advice. Outcome data was available at time of ED disposition, 48-h, and 14 days for 83, 62, and 54% of patients, respectively. Of participants followed-up, 4.3% died in the ED, 11.5% within 48 h, and 19.6% within 14 days.ConclusionsThis first epidemiological study at Pakistan's largest pediatric ED reveals dramatically high mortality, particularly among neonates. Future research in developing countries should focus on characterizing reasons for high mortality through pre-ED arrival tracking, ED care quality assessment, and post-ED follow-up.
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