Background Pneumonia, the leading reason underlying childhood deaths, may be triggered or exacerbated by air pollution. To date, only a few studies have examined the association of air pollution with emergency department (ED) visits for pediatric pneumonia, with inconsistent results. Therefore, we aimed to elucidate the impact of short-term exposure to particulate matter (PM) and other air pollutants on the incidence of ED visits for pediatric pneumonia. Methods PM 2.5 , PM 10 , and other air pollutant levels were measured at 11 air quality-monitoring stations in Kaohsiung City, Taiwan, between 2008 and 2014. Further, we extracted the medical records of non-trauma patients aged ≤17 years and who had visited an ED with the principal diagnosis of pneumonia. A time-stratified case–crossover study design was employed to determine the hazard effect of air pollution in a total of 4024 patients. Results The single-pollutant model suggested that per interquartile range increment in PM 2.5 , PM 10 , nitrogen dioxide (NO 2 ), and sulfur dioxide (SO 2 ) on 3 days before the event increased the odds of pediatric pneumonia by 14.0% [95% confidence interval (CI), 5.1–23.8%], 10.9% (95% CI, 2.4–20.0%), 14.1% (95% CI, 5.0–24.1%), and 4.5% (95% CI, 0.8–8.4%), respectively. In two-pollutant models, PM 2.5 and NO 2 were significant after adjusting for PM 10 and SO 2 . Subgroup analyses showed that older children (aged ≥4 years) were more susceptible to PM 2.5 (interaction p = 0.024) and children were more susceptible to NO 2 during warm days (≥26.5 °C, interaction p = 0.011). Conclusions Short-term exposure to PM 2.5 and NO 2 possibly plays an important role in pediatric pneumonia in Kaohsiung, Taiwan. Older children are more susceptible to PM 2.5 , and all children are more susceptible to NO 2 during warm days.

Background and objective: Public health interventions such as social distancing, wearing surgical or N95 masks, and handwashing are effective in significantly reducing the risk of infection. The purpose of this article is to analyze the effect of public health interventions on respiratory tract infection-related visits to pediatric emergency departments during the COVID-19 pandemic in Taiwan.Method: Pediatric emergency department visits between January 1 2020 and April 30 2020 were included for trend analysis and compared to the same period during the past 3 years. The datasets were retrieved from Taiwan National Infectious Disease Statistics System and Kaohsiung Chang Gung Memorial Hospital. Respiratory tract infections with other diagnoses categories, including fever, asthma, and urinary tract infections, were included for subgroup analysis.Result: A significant decrease of more than 50% in respiratory tract infection-related visits was found from February to April 2020 in the national database. With regard to diagnosis category, the proportion of respiratory tract infections in Kaohsiung Chang Gung Hospital also became significantly lower in 2020 during the months of March (43.4 vs. 37.4%, p = 0.024) and April (40.1 vs. 32.2%, p < 0.001). On the other hand, the proportion of urinary tract infections was significantly higher in 2020 during March (3.7 vs. 5.2%, p = 0.033) and April (3.9 vs. 6.5%, p < 0.001), and that of asthma was also higher in April (1.6 vs. 2.6%, p = 0.025). Furthermore, the intensive care unit admission rate was relatively higher in 2020 from February, with significant differences noted in March (1.3 vs. 2.8%, p < 0.001).Conclusion: Due to public health interventions for the COVID-19 pandemic, the transmission of not only COVID-19 but also other air droplet transmitted diseases in children may have been effectively prevented.

Elderly people are more susceptible to sepsis and experience more comorbidities and complications than young adults. Serum lactate is a useful biomarker to predict mortality in patients with sepsis. Lactate production is affected by the severity of sepsis, organ dysfunction, and adrenergic stimulation. Whether the predictive ability of serum lactate will be different between non-elderly and elderly patients is unknown.A retrospective cohort study was conducted to compare the prognostic value of hyperlactatemia in predicting the mortality between elderly (≥65 years) and non-elderly (<65 years) patients with sepsis.This is a single-center retrospective observational cohort study conducted from January 2007 to December 2013 in southern Taiwan. All patients with sepsis, who used antibiotics, with blood culture collected, and with available serum lactate levels in the emergency department, were included in the analysis. We evaluated the difference in serum lactate level between the elderly and non-elderly septic patients by using multiple regression models.A total of 7087 patients were enrolled in the study. Elderly and non-elderly patients accounted for 62.3% (4414) and 40.2% (2673) of all patients, respectively. Statistically significant difference of serum lactate levels was not observed between elderly and non-elderly survivors (2.9 vs 3.0 mmol/L; P = .57); however, elderly patients had lower lactate levels than those within the 28-day in-hospital mortality (5.5 vs 6.6 mmol/L, P < .01). Multiple logistic regression revealed higher adjusted mortality risk in elderly and non-elderly patients with lactate levels of ≥4.0 mmol/L (odds ratio [OR], 4.98 and 5.82; P < .01, respectively), and lactate level between 2 and 4 mmol/L (OR, 1.57 and 1.99; P < .01, respectively) compared to that in the reference group with lactate levels of <2.0 mmol/L in each group. In receiver operating characteristic curve analysis, sensitivity rates for predicting mortality were 0.80 and 0.77 for non-elderly and elderly patients, respectively, by using serum lactate levels higher than 2.0 mmol/L.Septic elderly non-survivors had 1 mmol/L lower serum lactate level than those of the non-elderly non-survivors. Lactate >2 mmol/L still could provide enough sensitivity in predicting sepsis mortality in elder patients.

Blood culture is frequently used to detect bacteremia in febrile children. However, a high rate of negative or false-positive blood culture results is common at the pediatric emergency department (PED). The aim of this study was to use machine learning to build a model that could predict bacteremia in febrile children. We conducted a retrospective case-control study of febrile children who presented to the PED from 2008 to 2015. We adopted machine learning methods and cost-sensitive learning to establish a predictive model of bacteremia. We enrolled 16,967 febrile children with blood culture tests during the eight-year study period. Only 146 febrile children had true bacteremia, and more than 99% of febrile children had a contaminant or negative blood culture result. The maximum area under the curve of logistic regression and support vector machines to predict bacteremia were 0.768 and 0.832, respectively. Using the predictive model, we can categorize febrile children by risk value into five classes. Class 5 had the highest probability of having bacteremia, while class 1 had no risk. Obtaining blood cultures in febrile children at the PED rarely identifies a causative pathogen. Prediction models can help physicians determine whether patients have bacteremia and may reduce unnecessary expenses.

The qSOFA scores are more accurate than SIRS scores for predicting 72-h mortality and are better at predicting 72-h mortality than 28-day mortality.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

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Objective This study assessed the effect of prior statin use on the 28-day mortality of patients with type 2 diabetes mellitus (DM) who develop bloodstream infections. Methods This retrospective cohort study included all adult type 2 DM patients with bacteremia and verified prior medication history who visited the emergency department of a single tertiary hospital between January 2007 and December 2013. All major adverse consequences including septic shock events, use of mechanical ventilation, intensive care unit admission, and 28-day mortality were assessed. Results A total of 1,979 patients were enrolled in the study, of whom 507 were taking statins. Statin users had less severe disease presentation and lower levels of sepsis biomarkers such as bandemia (1.3 ± 3.1 vs 1.8 ± 4.2). After adjustment for confounding variables using a Cox regression model, only older age (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI], 1.01–1.04), urinary tract infection (adjusted HR: 0.56, 95% CI, 0.43–0.75), and prior statin use (adjusted HR: 0.58, 95% CI: 0.42–0.85) were significantly associated with 28-day in-hospital mortality. Conclusion Prior statin treatment in patients with type 2 DM and bacteremia was associated with a lower 28-day in-hospital mortality rate.

Purpose: Cervical traumas are frequent in emergency department and X-ray, CT, and MRI are the essential imaging modalities in the diagnosis. However, especially for pregnant and morbid obese patients and children, these techniques can be challenging. We tested the success of point-of-care ultrasound in the evaluation of cervical traumas. Methods: This is a case series of cervical vertebra imaging with ultrasound in emergency department. We used linear probe and placed it anterolaterally to the neck, parallel to cervical spine. Images were obtained by an ultrasound-certified emergency physician. The height of the anterior wall of vertebral body, irregularity in vertebral body, and intervertebral space were assessed. Results: We presented a case series of six patients. Ultrasound images of cervical vertebral bodies and intervertebral spaces were able to obtain for all the patients. Any pathology was not observed in ultrasound imaging. This finding was compatible with cervical X-ray and CT scans and all the patients were discharged. Conclusions: However, this is a case series report of minor cervical trauma, and we were able to obtain ultrasound images of cervical vertebra bodies with point-of-care ultrasound examination by an emergency physician. This technique can be important for the patients contraindicated to CT or MRI. Also, it can give additional information to X-ray and CT scans especially for soft tissues. A2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasound