After the 2014-2015 Ebola outbreak, viruses causing hemorrhagic fever have garnered increasing international attention. Infection with Lassa virus is an important cause of fever in children in West Africa. Exact figures are unknown, but a study showed 6% of febrile admissions in Nigeria were due to Lassa fever. 1 Considering ever-increasing global migration, pediatricians should be aware of Lassa virus risk factors and treatment standards. The diagnosis should be considered by pediatricians in the United States treating children newly arrived from endemic areas, as Lassa virus may be an under recognized source of infection in this population. Virology and EpidemiologyLassa fever is caused by an RNA virus from the Arenaviridae family. The virus was first discovered in the village of Lassa, Nigeria, in 1969 when 2 missionary nurses contracted infection and died. Its most severe form causes hemorrhagic fever and shock. Most cases are reported in the "Lassa belt" of western Africa. In Guinea, Liberia, Nigeria, and Sierra Leone, cases are considered to be hyperendemic, and cases have been reported in Benin, Ghana, Mali, and Togo. Eight imported cases of Lassa virus in the United States have been reported since 1969. 2 Imported cases have also been reported in Japan, the United Kingdom, Germany, the Netherlands, and Israel. Outbreaks in Africa occur primarily in the dry season (November to April), and 338 suspected cases were reported in the first half of 2017 in Nigeria. 3 The estimated yearly incidence in West Africa is 100 000 to 300 000 cases and approximately 5000 deaths. Children under age 10 years are considered most vulnerable, with 1 study showing 15% seropositivity for Lassa virus in that population in West Africa. 4
Objectives. Previous studies in pediatric emergency departments (EDs) showed patients with limited English proficiency (LEP) had gaps in care compared with English-speaking patients. In 2010, the Joint Commission released patient-centered communication standards addressing these gaps. We evaluate the current care of LEP patients in the Children’s Healthcare of Atlanta (CHOA) EDs. Methods. This was a retrospective cohort study of patients <18 years that presented to our EDs in 2016. Length of stay (LOS), change in triage status, return-visit rates, and hospital disposition were compared between patients who requested an interpreter and those who did not. Results. The population included 152,945 patients from 232,787 ED encounters in 2016. Interpreters were requested for 12.1% of encounters. For ED LOS, a model-adjusted difference of 0.77% was found between interpreter groups. For change in triage status, adjusted odds were 7% higher in the interpreter requested cohort. For ED readmission within 7 days, adjusted odds were 3% higher in the interpreter requested cohort. These effect sizes are small (ES < 0.2). Conclusions. Our study showed low ES of the differences in ED metrics between LEP and English-speaking patients, suggesting little clinical difference between the two groups. The impact of this improvement should be further studied.
Background The travel screen was implemented by emergency departments (EDs) across the country in 2014 to detect patients exposed to Ebola early and prevent local outbreaks. It remains part of the triage protocol in many EDs to detect communicable disease from abroad and has become a defacto screen for other travel-related illness. Its utility has not been studied in the pediatric ED. Methods This was a retrospective review of electronic medical records across 3 EDs from January 1, 2016, to December 31, 2016. The screening question reads, “Has the child or a close contact of the child traveled outside the United States in the past 21 days?” A follow-up question requesting travel details is included for positive screens. We compared length of stay, return-visit rates, and differences in disposition between patients with positive and negative travel screens using generalized linear regression. Matched regression estimates, 95% confidence intervals, and P values were reported. Results The study population included 152,945 patients with a total of 322,229 encounters in 2016, of which 232,787 encounters had a travel screen documented during triage. There were 2258 patient encounters that had positive travel screens. Only 201 (8.9%) of these encounters had further description of the travel in the comments box. The odds of hospital admission for patients with positive travel screens were 1.76 (95% confidence interval, 1.54–2.01; P < 0.001) times the odds of hospital admission for patients screened negative. The significance of this finding was largely driven by general hospital admission. Other metrics did not differ significantly between the groups. Conclusions Although a positive travel screen was mildly predictive of inpatient admission, information is not available to providers about travel-related risk. Recent literature suggests integrating a travel history with presenting symptoms and region of travel and could produce a more specific travel screen. A revised travel screen should be implemented and studied in the pediatric ED.
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