Characteristics and outcomes of pediatric patients presenting at Cambodian referral hospitals without appointments: an observational study

Abstract

BackgroundEmergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals.MethodsChildren enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012. Researchers used standardized questionnaires and hospital records to collect demographic and clinical data. Patients were followed up at 48 h and 14 days after initial presentation. Multivariate logistic regression identified factors associated with hospital admission.ResultsThis study included 867 unscheduled visits. Mean patient age was 5.7 years (standard deviation 4.8 years). Of the 35 different presenting complaints, fever (63%), respiratory problems (25%), and skin complaints (24%) were most common. The majority of patients were admitted (51%), while 1% were transferred to another facility. Seven patients (1%) died within 14 days. Follow-up rates were 83% at 48 h and 75% at 14 days. Predictors of admission included transfer or referral from another health provider, seeking prior care for the presenting problem, low socioeconomic status, onset of symptoms within 24 h of seeking care, abnormal vital signs or temperature, and chief complaint of abdominal pain or fever.ConclusionsWhile the admission rate in this study was high, mortality was low. More effective identification and management of children who can be treated and released may free up scarce inpatient resources for children who warrant admission.Electronic supplementary materialThe online version of this article (10.1186/s12245-018-0172-0) contains supplementary material, which is available to authorized users.

Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

“…222 49113 4433 (38) 40 49149 (42) Janajati 2546 (44) 1068 (47) 932 (42) 193 (43) 117 4644 5031 (38) 161 (46) Dalit 507 (9) 219 (10) 193 (9) 30 719 78 ( Presentation to ED, n (%)* 08:00-16:00 weekdays 1037 (24) 481 (28) 322 (19) 96 2837 2023 (38) 24 (40) 54 2216:00-08:00 or holidays 465 (27) 567 (34) 76 (22) 56 3019 3217 (28) 67 (27) ICU or OT or Referred 341 (8) 126 7117 726 826 1418 307 1221 ( Other complaints included musculoskeletal, neurology, urinary, cardiovascular diseases or complaints, psychology, and other general complaints.…”

“…Broadly, infections and injuries are dominating in unselected pediatric emergency patients, and typically children in these EDs are young with a median age 2 to 7 years in studies including children up to 13 or 18 years. 25 , 27 Interestingly, several pediatric studies reported that boys are considerably overrepresented: in Pakistan 60% were boys, 22 a study from Malaysia reported male to female ratio of 1.5:1, 24 a Cambodian study reported 54% boys, 27 and a large study from India reported a male to female ratio of 3:1. 23 It is noteworthy that recent report 28 from the COVID19 epidemic in China also indicates over representation of males among hospitalized cases that may indicate a sex-related susceptibility to serious infections, related to male sex.…”

“…In our study injuries and suspected infections dominated the presenting complaints in children <16 year of age. We have identified 6 studies [22][23][24][25][26][27] that have described the disease spectrum of pediatric emergency patients in Asian LMICs, and some patterns are remarkably similar across studies. Broadly, infections and injuries are dominating in unselected pediatric emergency patients, and typically children in these EDs are young with a median age 2 to 7 years in studies including children up to 13 or 18 years.…”

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

“…using written referral slips increases the likelihood a given referral will be successfully completed 11 , and can improve the accuracy and reduce redundancy of care provided by receiving practitioners. 34 , 35 The use of such communication tools is recommended by many expert groups and systems, including the WHO's Integrated Management of Childhood Illness program.…”

“…Also, without a structured referral communication system, communication of critical patient information from referring providers to ambulance staff and receiving providers is sporadic, leading to gaps and delays in care. 11 With only a small number of facilities having adopted referral qualityimprovement and feedback measures, challenges are slow to be identified and addressed.…”