OBJECTIVE:Headaches represent 0.9% to 2.6% of visits to a pediatric emergency department (PED). We noted a trend of increasing visits for headache in our tertiary care PED and sought to further characterize this trend.
METHODS:We identified PED visits with International Classification of Disease, Ninth Revision, Clinical Modification diagnoses for headache at 25 hospitals in Pediatric Health Information System between 2003 and 2013. To further characterize demographics and treatment trends over time we used the electronic health record in our emergency department to identify children ages four to 18 between January 2007 and December 2014 with International Classification of Disease, Ninth Revision codes for headache: a random sample of 50 visits per year were chosen for chart review.
RESULTS:Pediatric Health Information System visits for headache increased by 166% (18,041 in 2003 and 48,020 in 2013); by comparison, total PED visits increased by 57.6%. The percent admission increased by 300% (2020 admissions in 2003 and 8087 admissions in 2013). At our hospital, headache visits increased 111% from 896 visits in 2007 to 1887 visits in 2014; total PED visits increased 30.2%. The admission percentage for headache increased 187% with 156 admissions in 2007 and 448 in 2014. Management over time differed in the frequency of head computed tomography which decreased 3.7% per year (r = −0.93, 95% CI −0.99, −0.64) from 34% in 2007 to 18% in 2014.
CONCLUSION:Pediatric emergency department visits for headache are increasing and a growing proportion of these patients are admitted. This finding identifies a potential patient population to target for interventions to improve outpatient management and reduce pediatric emergency department utilization.
The issue is further confounded by thresholds for hypothermia ranging from 35.0-36.5°C. 2,4-10 The World Health Organization defines hypothermia in newborns as mild 36.0-36.5°C, moderate 32.0-36.°C and severe <32.0°C 11. The International Pediatric Sepsis Consensus Conference considers 36.0°C as the threshold for hypothermia for all age groups. 4 The normal temperature range measured by rectal thermometer is 36.6-37.9°C.
Symptoms of coronavirus disease 2019 overlap with other important illnesses affecting young adults. We report a case of a 17‐year old male presenting to the emergency department in the midst of a pandemic with symptoms of coronavirus disease 2019. He had fever, dyspnea, chest pain, and myalgias, with bilateral infiltrates on chest radiograph, and developed septic shock secondary to infectious thromboembolic events. However, his blood cultures grew group G streptococcus secondary to his oropharyngeal infection, and he experienced an infectious thrombus in the internal jugular vein, consistent with the rare but well‐described Lemierre's syndrome. This case report calls attention to the importance of maintaining differential diagnoses and thereby minimizing the biases and assumptions that come with clinical care during a pandemic.
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