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Purpose: Fluid therapy for diarrhea-induced dehydration inadvertently increases emergency department length of stay (EDLOS). To prevent this delay, we investigated the usefulness of triage using point-of-care (POC) lactate in infants with diarrhea.Methods: This study was performed on infants with diarrhea who visited the emergency department from January 2019 through December 2020. According to the POC lactate concentration and the Korean Triage and Acuity Scale (KTAS) level, the infants were separately divided into the low (< 2 mmol/L), moderate (2-3.9), and high (≥ 4) lactate groups and the mild (KTAS 4-5) and severe (1-3) groups, respectively. Using these 2 group designations, we compared variables regarding the emergency medicine resource use and outcomes. To predict the prolonged EDLOS (≥ median value) we performed logistic regression and receiver operating characteristic analyses.Results: A total of 540 infants were included. The median of EDLOS was 169 minutes (interquartile range, 103-220). Fluid therapy was more frequently performed in the high lactate group than in the low-moderate lactate groups (85.0% vs. 60.4%-73.6%; P = 0.025). The high lactate and severe groups respectively showed higher rates of hospitalization (40.0% vs. 3.8%-7.6% [P < 0.001] and 10.9% vs. 1.4% [P = 0.015]), and longer median EDLOS (259 minutes vs. 147-178 [P < 0.001] and 185 vs. 131 [P = 0.001]) compared to the low-moderate lactate and mild groups. Compared to the KTAS, lactate is more strongly associated with the prolonged EDLOS (lactate, adjusted odds ratio, 4.80 [95% confidence interval, 1.87-15.34] vs. KTAS, 3.52 [1.90-6.54]). The areas under curve for lactate and for the KTAS were 0.66 (0.60-0.73) and 0.62 (0.55-0.69), respectively (P = 0.058).Conclusion: In infants with diarrhea, POC lactate can be a predictor of emergency medicine resource use and outcomes.
Purpose: Fluid therapy for diarrhea-induced dehydration inadvertently increases emergency department length of stay (EDLOS). To prevent this delay, we investigated the usefulness of triage using point-of-care (POC) lactate in infants with diarrhea.Methods: This study was performed on infants with diarrhea who visited the emergency department from January 2019 through December 2020. According to the POC lactate concentration and the Korean Triage and Acuity Scale (KTAS) level, the infants were separately divided into the low (< 2 mmol/L), moderate (2-3.9), and high (≥ 4) lactate groups and the mild (KTAS 4-5) and severe (1-3) groups, respectively. Using these 2 group designations, we compared variables regarding the emergency medicine resource use and outcomes. To predict the prolonged EDLOS (≥ median value) we performed logistic regression and receiver operating characteristic analyses.Results: A total of 540 infants were included. The median of EDLOS was 169 minutes (interquartile range, 103-220). Fluid therapy was more frequently performed in the high lactate group than in the low-moderate lactate groups (85.0% vs. 60.4%-73.6%; P = 0.025). The high lactate and severe groups respectively showed higher rates of hospitalization (40.0% vs. 3.8%-7.6% [P < 0.001] and 10.9% vs. 1.4% [P = 0.015]), and longer median EDLOS (259 minutes vs. 147-178 [P < 0.001] and 185 vs. 131 [P = 0.001]) compared to the low-moderate lactate and mild groups. Compared to the KTAS, lactate is more strongly associated with the prolonged EDLOS (lactate, adjusted odds ratio, 4.80 [95% confidence interval, 1.87-15.34] vs. KTAS, 3.52 [1.90-6.54]). The areas under curve for lactate and for the KTAS were 0.66 (0.60-0.73) and 0.62 (0.55-0.69), respectively (P = 0.058).Conclusion: In infants with diarrhea, POC lactate can be a predictor of emergency medicine resource use and outcomes.
Purpose: This study was performed to investigate the coronavirus disease 2019 pandemic-related changes in visiting pattern of an emergency department (ED).Methods: The author investigated all children younger than 19 years who visited the ED from 2018 through 2020 without exclusion criteria. Pandemic period was defined as 2020. Variables of interest were monthly and annual numbers of visits, age and age groups (< 1, 1-4, 5-9, 10-14, and 15-18 years), sex, visits for diseases, disposition, high acuity, and top 5 chief complaints per each age group. Timing of social distancing and influenza-related visits were additionally analyzed to speculate the impact of such variables on the visiting patterns.Results: The annual visits were 11,435 (2018), 10,741 (2019), and 5,626 (2020), with a 47.6%-50.8% pandemic-related decrease. Trauma-related visits increased from 27.7%-28.4% to 36.5% (P < 0.001). In the children aged 9 years or younger, trauma as a chief complaint increased from 22.2%-29.6% to 36.2%-42.5% while fever decreased from 27.7%-47.3% to 16.7%-42.6%. In the pre-pandemic period, visits increased in February-March and October-December with a sharp increase in influenza-related visits in the latter 3 months. During the pandemic, a sharp decline in the visits was noted in January-February without the above-mentioned increasing patterns in neither total nor influenza-related visits. After the social distancing was implemented in the 13th week of 2020, the visits remained steady until a slight increase was noted after the school opening.Conclusion: During the pandemic period, a decrease was noted in the numbers of visits to the ED, along with decreases in fever as a chief complaint in young children and influenza-related visits, and the mitigation of social distancing. These findings could be useful in preparing emergency medicine resources for ongoing and future pandemics.
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