Pediatric Emergencies Admitted in the Resuscitation Room of a Swiss University Hospital

Lutz, Nicolas; Vandermensbrugghe, Nicole Gandillon; Dolci, Mirko; Amiet, Viviane; Racine, Laurence; Carron, Pierre‐Nicolas

doi:10.1097/pec.0000000000000231

Cited by 12 publications

(21 citation statements)

References 20 publications

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“…The existing data show comparable numbers of critical PED visits. International reports range from 0.7% in the UK and Korea (18,19), 0.6% in southern France (6) and Australasia (20), 0.45% in western Switzerland (11), and 0.3% in western Canada (21). Central nervous system disorders were the most frequent presenting problem in our sample, which was also reported in cohorts examined in the US (10), western Switzerland (11), and in the UK (18).…”

Section: Discussionsupporting

confidence: 68%

“…Publications analyzing the epidemiology of critically ill children in the PED are scarce (6)(7)(8)(9)(10)(11). One study from Western Switzerland describes a cohort of patients in the resuscitation bay (11). However, we found no recent data for central Europe or Switzerland since the introduction of PEM.…”

Section: Introductionmentioning

confidence: 71%

“…International reports range from 0.7% in the UK and Korea (18,19), 0.6% in southern France (6) and Australasia (20), 0.45% in western Switzerland (11), and 0.3% in western Canada (21). Central nervous system disorders were the most frequent presenting problem in our sample, which was also reported in cohorts examined in the US (10), western Switzerland (11), and in the UK (18). Many of these were seizures with clear-cut treatment algorithms; the remainder were presentations with altered mental status (non-intoxications).…”

Section: Discussionmentioning

confidence: 99%

“…The general epidemiological spectrum of PED presentations has been examined in various regions worldwide (2)(3)(4)(5). Publications analyzing the epidemiology of critically ill children in the PED are scarce (6)(7)(8)(9)(10)(11). One study from Western Switzerland describes a cohort of patients in the resuscitation bay (11).…”

Section: Introductionmentioning

confidence: 99%

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Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

et al. 2021

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Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission.Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018–2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital.Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%).Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

et al. 2021

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“…Survival rate for CPR lasting less than 15 min is estimated at 41%, decreasing to 12% after 35 min [ 8 ]. A recent study reported that average time spent in the pediatric shock room was 46 min [ 25 ]. Care for postcardiac arrest patients is also time-sensitive.…”

Section: Discussionmentioning

confidence: 99%

A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Siebert¹,

Ehrler²,

Combescure³

et al. 2017

J Med Internet Res

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BackgroundDuring pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.ObjectiveThe aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.MethodsThe study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.ResultsA total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.ConclusionsIn this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.

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Polytrauma bei Kindern und Jugendlichen

Schmittenbecher¹

2018

Pädiatrische Endokrinologie Und Diabetologie

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Pediatric Emergencies Admitted in the Resuscitation Room of a Swiss University Hospital

Abstract: The LTP emergencies accounted for a small proportion of all pediatric emergencies. They were more medical than surgical cases and resuscitation measures because of hemodynamic instability were the most frequent treatment.

Cited by 12 publications

References 20 publications

Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Polytrauma bei Kindern und Jugendlichen

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