Transient and Adult Patients with Neurologic Diseases in the Pediatric Emergency Department: Trends and Characteristics
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose There is an increasing rate of presentations by transient and adult patients (TAPs) to pediatric emergency departments (PED-EDs). TAPs with neurologic diseases (N-TAPs) comprise most of these patients. We investigated this trend and compared the characteristics of N-TAPs with those of pediatric patients with neurologic diseases (N-PEDs) who presented to the PED-ED of a tertiary-care hospital in Korea. Methods We reviewed the medical records of neurologic patients who presented to the PEDED of a single tertiary-care hospital from 2013 to 2017. We included patients with neurologic symptoms or diseases and those who were treated in the pediatric neurology department and underwent neurologic evaluations and treatment in the PED-ED. Results Presentations by N-TAPs to the PED-ED increased over time, whereas the number of N-PEDs gradually decreased, with a significant difference between the groups (p<0.001). The number of N-TAPs who presented to the PED-ED almost tripled from 2013 to 2017. NTAPs had significantly more acute symptoms than N-PEDs, and a significantly higher proportion of N-TAPs were insured by Medical Aid compared to N-PEDs (p<0.001). The admission rate was significantly higher (p<0.001) and the mean hospital stay was longer (p=0.046) for NTAPs. Epilepsy and neurometabolic diseases were mainly responsible for the increased presentations by N-TAPs. Conclusions We have clarified the status of N-TAPs in the PED-ER and the role of pediatric neurologists who manage them. Multidisciplinary treatments focusing on the role of pediatric neurologists should be developed to that systematic long-term care plans are applied to N-TAPs.
Abstract
Background and Purpose There is an increasing rate of presentations by transient and adult patients (TAPs) to pediatric emergency departments (PED-EDs). TAPs with neurologic diseases (N-TAPs) comprise most of these patients. We investigated this trend and compared the characteristics of N-TAPs with those of pediatric patients with neurologic diseases (N-PEDs) who presented to the PED-ED of a tertiary-care hospital in Korea. Methods We reviewed the medical records of neurologic patients who presented to the PEDED of a single tertiary-care hospital from 2013 to 2017. We included patients with neurologic symptoms or diseases and those who were treated in the pediatric neurology department and underwent neurologic evaluations and treatment in the PED-ED. Results Presentations by N-TAPs to the PED-ED increased over time, whereas the number of N-PEDs gradually decreased, with a significant difference between the groups (p<0.001). The number of N-TAPs who presented to the PED-ED almost tripled from 2013 to 2017. NTAPs had significantly more acute symptoms than N-PEDs, and a significantly higher proportion of N-TAPs were insured by Medical Aid compared to N-PEDs (p<0.001). The admission rate was significantly higher (p<0.001) and the mean hospital stay was longer (p=0.046) for NTAPs. Epilepsy and neurometabolic diseases were mainly responsible for the increased presentations by N-TAPs. Conclusions We have clarified the status of N-TAPs in the PED-ER and the role of pediatric neurologists who manage them. Multidisciplinary treatments focusing on the role of pediatric neurologists should be developed to that systematic long-term care plans are applied to N-TAPs.
참고문헌 (26)
- Camfield PR, "What happens to children with epilepsy when they become adults? Some facts and opinions", Pediatr Neurol, 51, pp.17~23 (2014)
- Davis AM, "Transition care for children with special health care needs", Pediatrics, 134, pp.900~908 (2014)
- Goodman DM, "Adults with chronic health conditions originating in childhood : inpatient experience in children’s hospitals", Pediatrics, 128, pp.5~13 (2011)
- Borlot F, "Epilepsy transition : challenges of caring for adults with childhood-onset seizures", Epilepsia, 55, pp.1659~1666 (2014)
- Andrade DM, "Epilepsy: transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force", Epilepsia, 58, pp.1502~1517 (2017)
- Wakamoto H, "Long-term medical, educational, and social prognoses of childhood-onset epilepsy : a population-based study in a rural district of Japan", Brain Dev, 22, pp.246~255 (2000)
- Camfield P, "The transition from pediatric to adult care for youth with epilepsy : basic biological, sociological, and psychological issues", Epilepsy Behav, 69, pp.170~176 (2017)
- Okumura MJ, "Comfort of general internists and general pediatricians in providing care for young adults with chronic illnesses of childhood", J Gen Intern Med, 23, pp.1621~1627 (2008)
- McDonnell WM, "Pediatric emergency department use by adults with chronic pediatric disorders", Arch Pediatr Adolesc Med, 164, pp.572~576 (2010)
- Geerlings RP, "Transition to adult medical care for adolescents with epilepsy", Epilepsy Behav, 44, pp.127~135 (2015)
- Bourgeois FT, "Adult patient visits to children’s hospital emergency departments", Pediatrics, 111, pp.1268~1272 (2003)
- Little WK, "Adult patients in the pediatric emergency department : presentation and disposition", Pediatr Emerg Care, 30, pp.808~811 (2014)
- 이봉진, "Clinical Considerations When Applying Vital Signs in Pediatric Korean Triage and Acuity Scale", Journal of Korean Medical Science, 32(10), pp.1702~1707 (2017), 대한의학회
- Kim JH, "The differences in health care utilization between Medical Aid and health insurance : a longitudinal study using propensity score matching", PLoS One, 10, pp.e0119939~ (2015)
- Kim JH, "Impact of continuous Medical Aid utilisation on healthcare utilisation : unique insight using the 2008-2012 Korean Welfare Panel Study(KOWEPS)", BMJ Open, 6, pp.e008583~ (2016)
- Rhine T, "Prevalence and trends of the adult patient population in a pediatric emergency department", Pediatr Emerg Care, 28, pp.141~144 (2012)
- Nabbout R, "Outcome of childhood-onset epilepsy from adolescence to adulthood : transition issues", Epilepsy Behav, 69, pp.161~169 (2017)
- Nabbout R, "Treatment issues for children with epilepsy transitioning to adult care", Epilepsy Behav, 69, pp.153~160 (2017)
- Camfield C, "Preventable and unpreventable causes of childhood-onset epilepsy plus mental retardation", Pediatrics, 120, pp.e52~e55 (2007)[DOI]
- "Final results of birth statistics in 2016" (2017)[URL]
- "International statistical yearbook:total fertility rate OECD" (2018)[URL]
- Michihata N, "Clinical features of adult patients admitted to pediatric wards in Japan", J Adolesc Health, 57, pp.421~424 (2015)
- Edwards JD, "Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units", J Crit Care, 30, pp.201~206 (2015)
- Chiron C, "Pharmacology aspects during transition and at transfer in patients with epilepsy", Epilepsia, 55, pp.8~11 (2014)
- Affdal AO, "A difficult transition from childhood to adult healthcare : the case of epilepsy", Arch Pediatr, 22, pp.337~342 (2015)
- Young S, "Avoiding the ‘twilight zone’ : recommendations for the transition of services from adolescence to adulthood for young people with ADHD", BMC Psychiatry, 11, pp.174~ (2011)