Non-Urgent Paediatric Emergency Department Visits: Why Are They So Common? A Singapore Perspective

Ganapathy, Sashikumar; Lim, Soo Yen; Kua, Jade; Ng, Kee Chong

doi:10.47102/annals-acadmedsg.v44n7p269

Cited by 8 publications

(2 citation statements)

References 13 publications

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“…It is possible that behavioural change accounted for the study's 2019 spike and subsequent plateau; however, there was consistency in the healthcare system during this period. We observed stability in the total number of ED visits for all causes, and for allergy‐related codes, from 2015 to 2019 and the pre‐existing trend of non‐urgent visits to the paediatric ED in Singapore had been highlighted in a 2015 commentary [41] and echoed in 2018 report [42]. As such, the paediatric ED was a well‐placed location to study the multi‐systemic presentation of anaphylaxis among milder complaints.…”

Section: Discussionmentioning

confidence: 69%

Trends in Childhood Anaphylaxis in Singapore: 2015–2022

Goh,

Yap,

Cheng

et al. 2024

Clin Experimental Allergy

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BackgroundThere has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood anaphylaxis in Singapore.MethodsThis was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy‐related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD‐9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included.ResultsA total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person‐years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval [CI] 1.70–2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person‐years, IRR 2.39 (95% CI 1.90–3.01) and drug anaphylaxis was 4.6 per 100,000 person‐years, IRR 1.89 (95% CI 1.11–3.25). The incidence rate in children aged 0–4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non‐steroidal anti‐inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy‐related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high‐dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40–1.83) and 0.7, IRR 1.77 (95% CI 0.54–5.76) per 100,000 person‐years, respectively.ConclusionWhile the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy‐related visits, anaphylactic shock and anaphylaxis requiring high‐dependency and intensive care did not rise.

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Section: Discussionmentioning

confidence: 69%

Trends in Childhood Anaphylaxis in Singapore: 2015–2022

Goh,

Yap,

Cheng

et al. 2024

Clin Experimental Allergy

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“…The nature of the healthcare system in Singapore is unique. Up to 60% of the consultations in the paediatric ED were for nonurgent conditions due to the overall perception of the severity of symptoms and parental preference towards paediatric specialist facilities (Ganapathy et al, 2015). This would lead to an increased workload for the paediatric ED.…”

Section: Introductionmentioning

confidence: 99%

Perceptions and coping strategies of junior doctors in a Paediatric Emergency Department in Singapore

Tan

Badron

Ganapathy

2023

TAPS

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Introduction: Perceptions towards the working and learning environment as well as coping mechanisms have been studied across different healthcare sectors. They have shown to reduce stress and burnout. However, perceptions of the work environment in the Emergency Department (ED) setting have not been studied in depth. The literature surrounding coping mechanisms also mostly focuses on their impacts rather than the mechanisms utilised. In addition, these were often investigated using surveys. This study aimed to use a phenomenological approach to explore the perceptions and coping strategies of junior doctors working in a paediatric ED. Methods: Sixteen junior doctors working in the Paediatric ED were recruited. Semi-structured interviews were conducted after conducting literature reviews. Data was collected until saturation point. All interviews were recorded and transcribed verbatim manually and subsequently analysed. Results: The greatest fears of junior doctors starting their paediatric emergency posting were lack of knowledge due to inexperience in the subspecialty; fear of the work environment due to unfamiliarity as well as workload and the intrinsic high-stress environment. The main coping strategies were ensuring clinical safety, obtaining psychosocial support from loved ones and colleagues, and placing focus on spirituality and wellbeing. Conclusion: In this study, the perceptions and coping strategies of the junior doctors in the Paediatric ED were explored. The findings from this study will help to structure and improve the support given to future junior doctors who rotate to the department as well as better orientate them to allay their pre-conceived notions.

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