Preliminary comparison of length of stay of patients treated by 3 board-certified physicians and 1 pediatric resident in the emergency department during night shifts

배고은,은소현,윤서희,김문규,구청모 대한소아응급의학회 2022 대한소아응급의학회지 Vol.9 No.1

Shortage of doctors in emergency departments (EDs) is a root issue in maintaining ED-based residency programs. This study describes the efficiency of emergency practice according to board certification; 3 board-certified physicians versus a pediatric resident. Of 342 children, we found no differences as per the board certification in the ED length of stay, acuity, and return visits with more frequent hospitalization by the board-certified physicians. This result suggests that with a proper residency program, both board-certified physicians and residents can make a decision on hospitalization.

열과 발진을 주소로 응급실을 방문한 47일 여아에서 진단된 신생아 루푸스

신윤겸,강지만,안종균 대한소아응급의학회 2021 대한소아응급의학회지 Vol.8 No.1

Neonatal lupus (NL) is a passively acquired autoimmune disease that occurs in infants born from asymptomatic mothers having anti-SSA or anti-SSB antibody. Infants with NL may show symptoms of systemic lupus erythematosus, including skin rash, congenital heart block, hepatic dysfunction, and hematological abnormalities. Mothers of the infants are asymptomatic or diagnosed with autoimmune diseases. When infants born to asymptomatic mothers who have never been diagnosed with the diseases show symptoms of NL, they may be mistaken for having infections. We report an NL case of a 47-day-old girl who presented to the emergency department with fever and skin rash.

심부정맥혈전증으로 오인된 데스모이드종양에 의한 외장골정맥 압박 1례

고찬영 대한소아응급의학회 2021 대한소아응급의학회지 Vol.8 No.2

Desmoid tumor, also known as desmoid-type fibromatosis, is a rare, intermediate, locally aggressive tumor with a high possibility of local infiltration and recurrence, potentially leading to life-threatening problems. We report a case of a 15-year-old girl who visited the emergency department with a 1-week history of the left leg swelling. A point-of-care ultrasound on the leg showed dilated left femoral and popliteal veins. Subsequently, a computed tomography venogram demonstrated a large pelvic mass compressing the left external iliac vein. She underwent tumor resection, and was uneventfully discharged on day 12.

단일 권역외상센터에 방문한 소아청소년 환자의 나이대별 특성과 중증외상에 영향을 미치는 인자 분석

이형원,최재연,장재호,조진성,현성열,최우성,우재혁 대한소아응급의학회 2020 대한소아응급의학회지 Vol.7 No.2

Purpose: The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. Methods: We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. Results: Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [interquartile range, 6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). Conclusion: In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.

단일기관 응급실에서 침습적 B군 사슬알균감염으로 진단된 90일 미만 영아의 임상적 특성

김미진,오기원 대한소아응급의학회 2023 대한소아응급의학회지 Vol.10 No.2

Purpose: We aimed to characterize invasive group B streptococcal infection (IGBSI) in young infants hospitalized through the emergency department. Methods: We analyzed medical records of infants younger than 90 days with IGBSI, defined as group B streptococcus bacteremia or meningitis, who visited the emergency department from January 2009 through December 2021. Their clinical features were compared as per 2 criteria, neonates and meningitis. For the comparisons, we defined 2 composite outcomes, “clinically important abnormality (any of the followings: temperature > 38.5。C, leukocytes < 5,000/mm3 or > 15,000/mm3, absolute neutrophils > 4,000/mm3 or C-reactive protein > 2.0 mg/dL)”and “poor outcomes (any of the followings: intensive care unit, transfer, seizure or complications).”Percentages are rounded to the first decimal places. Results: A total of 35 infants, of whom 15 (43%) were neonates and 17 (49%) were boys, had IGBSIs, including 23 infants (66%) with isolated bacteremia, 11 (31%) with bacteremia with meningitis, and 1 (3%) with isolated meningitis. Ill appearances were noted in 27 infants (77%) who encompassed all with meningitis. The other 8 infants (23%) looking well had 1 or more components of the clinically important abnormality. The neonates showed a higher frequency of vaginal delivery (87% vs. 35%; P = 0.002) and a lower frequency of a temperature > 38.5℃, compared to their counterparts (47% vs. 80%; P = 0.040). The infants with meningitis had a longer median time required to visit (5.0 vs. 2.0 hours; P = 0.011), and higher frequencies of ill appearance (100% vs. 65%; P = 0.032), leukocytes < 5,000/mm3 (67% vs. 13%; P = 0.002), and the poor outcomes (75% vs. 0%; P < 0.001). Conclusion: Young infants with ill-looking appearance or abnormality in any of the fever or inflammatory markers may have IGBSIs, particularly meningitis.

급성 세기관지염 연관 응급실 재방문의 위험인자

국윤준,이종승,류정민 대한소아응급의학회 2021 대한소아응급의학회지 Vol.8 No.2

Purpose: Acute bronchiolitis (AB)-related return visits incur overuse of emergency medicine resources, crowding of emergency departments (EDs), and deterioration of rapport with the guardians. The authors aimed to analyze factors associated with the return visits to the ED. Methods: This study was conducted based on the medical records of 447 children aged 24 months or younger with AB who visited the ED from January 2019 through December 2020. A return visit was defined as an AB-related visit to the ED within 7 days of index visit. According to the return visit, we compared the clinical features. Multivariable logistic regression was conducted to identify independent factors for the return visit. Results: Of the 323 children with AB, 77 (23.8%) made return visits. The returning children showed a younger median age (6 [interquartile range, 2-10] vs. 8 months [3-14]; P < 0.001), a lower mean oxyhemoglobin saturation (92.9 ± 4.3% vs. 97.1 ± 1.8%; P < 0.001), and higher frequencies of congenital heart diseases (22.1% vs. 10.6%; P = 0.009) and bronchopulmonary dysplasia (11.7% vs. 5.7%; P = 0.013), and respiratory syncytial virus infection (57.1% vs. 37.0%; P = 0.002). No other variables, such as the hospitalization rate, differed as per return visits. The factors associated with return visits were respiratory syncytial virus infection (adjusted odds ratio, 9.41; 95% confidence interval, 2.13-41.57), lower oxygen saturation (2.00; 1.64-2.43), and age younger than 3 months (1.25; 1.07-1.24). Conclusion: AB-related return visits may be associated with age younger than 3 months, lower oxygen saturation, and respiratory syncytial virus infection.

Severe lupin bean intoxication: an anticholinergic toxidrome

Pinar Yazici Ozkaya,Hatice Feray Ari,Ese Eda Turanli,Gulizar Koc,Bulent Karapinar 대한소아응급의학회 2021 대한소아응급의학회지 Vol.8 No.2

Lupin beans are the yellow legume seeds of the genus Lupinus. They are traditionally eaten as a pickled snack in many countries. Bitter lupin beans have a high amount of alkaloids called lupanine. Because the alkaloid is responsible for anticholinergic toxidrome, the beans should pass a debittering process before consumption. Only few pediatric cases of lupin bean intoxication were reported. We present a 12-year-old boy who visited the emergency department for the unexpected onset of anticholinergic toxidrome.

신생아 약동학과 약물요법

조혜정 대한소아응급의학회 2017 대한소아응급의학회지 Vol.4 No.1

Neonates include both full term and preterm infants up to 28 days of age. The heterogeneity and rapid physiologic change of neonates affect all aspects of pharmacokinetics such as absorption, distribution, metabolism, and elimination. This feature should be considered in determining the dose and regimen of drug therapy in neonates. However, the research on the safety and efficacy of specific drugs is limited due to ethical and technical issues. This review article focuses on the neonatal pharmacokinetics and the rationales of drug therapy in neonates based on findings of previous studies and empirical evidence. .

응급실에서 시행하는 해열방법에 대한 보호자 선호도 분석

김혜정,김호중 대한소아응급의학회 2018 대한소아응급의학회지 Vol.5 No.1

Purpose: To investigate caregivers’ preference regarding fever management in the emergency department. Methods: Between July 2011 and June 2014, we surveyed the preference in fever management by caregivers of febrile children aged 7 years or younger who visited the emergency department. The questionnaire consisted of the characteristics of the children and their caregivers, usefulness of tepid massage, and the caregivers’ preference in fever management, in particular the combination of methods and the doses of antipyretics. Results: Among a total of 161 children, 161 were enrolled in the study, with the mean age of 5.0 years. Of the caregivers, 64.6% were in their 30s and 50.9% were parents, and 70.2% and 24.2% reported that tepid massage was “very useful” and “a little useful,” respectively. The most preferred combination of methods was “tepid massage, acetaminophen, and ibuprofen (50.9%; P < 0.001).” “Tepid massage and ibuprofen” was preferred to “tepid massage and acetaminophen (24.2% vs 7.5%).” The most preferred dose of antipyretics was 1 mL/kg/day (divided into 3 doses; 60.2%; P = 0.012), followed by 1 mL/kg/day (divided into 3 doses) plus 2 mL/dose (29.1%). Conclusion: Caregivers may recognize tepid massage as a useful fever management. The most preferred fever management was the combination of tepid massage, acetaminophen, and ibuprofen with a dose of 1 mL/kg/day.

응급실을 방문한 소아 치과 손상 환자의 나이대별 역학적 특징

김선우,최재연,조진성,우재혁,장재호,최우성,현성열 대한소아응급의학회 2022 대한소아응급의학회지 Vol.9 No.2

Purpose: The aim of this study was to investigate the epidemiologic features of pediatric dental injury according to age groups using Korean national data. Methods: We reviewed the data from 2015 to 2019 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. We included children aged 18 years or younger with the International Classification of Disease, 10th Revision codes related to dental injury. Other or combined codes were excluded. The children were classified by age groups: infants (< 1 year), preschoolers (2-6), schoolers (7-12), and adolescents (13-18). As per the age groups, we compared the clinical characteristics, injury event profiles, and outcomes. Results: The study population (n = 33,020) consisted of 8,900 infants (27.0%), 15,705 preschoolers (47.6%), 5,295 schoolers (16.0%), and 3,120 adolescents (9.4%). Their median age was 3 years (interquartile range, 1-7), and boys accounted for 64.2%. The most common mechanism, type of activity, and place were slip down (14,274 [43.2%]), daily activity (23,777 [72.0%]), and home (19,980 [60.5%]), respectively. Among the injury types, soft tissue injury was most common (24,357 [73.8%]). As for the outcomes, 32,841 (99.5%) children were discharged, and 332 (1.0%) children had severe injury. As the age increased, the frequencies changed as follows. As for the place and type, household injury and soft tissue injury decreased while outdoor injury, such as road traffic injury, and tooth fracture increased (P < 0.001). As for the type of activity, injuries related to exercise/sports and education increased (P < 0.001). Of the sports activity, ball sports increased while kickboard/cycle decreased (P < 0.001). Conclusion: Using the epidemiologic features of pediatric dental injury, it is advisable to establish injury prevention strategies according to the age groups.