標題: Emergency room visits and admission rates of children with neuromuscular disorders: A 10-year experience in a medical center in Taiwan
作者: Kao, Wei-Tsun
Tseng, Yung-Hao
Jong, Yuh-Jyh
Chen, Tai-Heng
交大名義發表
National Chiao Tung University
關鍵字: emergency room;neuromuscular disorders;pediatrics;respiratory failure
公開日期: 1-八月-2019
摘要: Background: No previous studies have explored emergency medical care for children with chronic neuromuscular disorders (NMDs). We aimed to determine the major reasons for the emergency room (ER) readmission of pediatric patients with NMDs and suggest changes to the care plan to decrease readmissions. Methods: Children with chronic NMDs (aged <18 years) who visited a medical center-based ER between January 2005 and January 2015 were included. The following data were extracted from the patient's ER records: presentations; demographic data, including sex and age; NMD diagnosis; triage classification; emergency examination; initial management and outcomes. The outcomes were death inside or outside the ER, admission to the ward or pediatric intensive care unit (PICU), uneventful discharge, and repeated ER visits. Results: In 10 years, 44 children with heterogeneous NMDs (boys/girls: 30/14, mean age: 9.9 years) visited the ER for a total of 204 times. Repeated ER visits and readmissions occurred in 56.8% and 55.6% of the patients, respectively. Most NMD children belonged to triage class 3 (35.3%), with underlying congenital hereditary muscular dystrophy (44.1%). The major symptoms were usually multiple and concurrent, and primarily respiratory (62.3%) or gastrointestinal (28.9%). The most common causes of hospitalization were pneumonia (48.5%) or acute gastritis (20.4%), and approximately half of the ER visits required further hospitalization, of which 28.2% involved PICU admission. Twenty of the 36 children admitted to the ER required readmission. The most commonly prescribed examinations were complete blood count (38%) and C-reactive protein (38%), and the most common therapy was intravenous fluid administration (34%). Although respiratory compromise caused most ER visits and admissions, pulmonary assessments, including chest films (28%), pulse oximetry (15%), and blood gas analysis (11%), were performed in a relatively small proportion. Conclusion: The ER staff must recognize patients' unmet needs for respiratory and gastrointestinal care related to underlying NMDs. Copyright (C) 2018, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.
URI: http://dx.doi.org/10.1016/j.pedneo.2018.09.008
http://hdl.handle.net/11536/152602
ISSN: 1875-9572
DOI: 10.1016/j.pedneo.2018.09.008
期刊: PEDIATRICS AND NEONATOLOGY
Volume: 60
Issue: 4
起始頁: 405
結束頁: 410
顯示於類別:期刊論文