Epidemiology of Pediatric Critically-ill Patients Presenting to the Pediatric Emergency Department

Abstract

Background:

This study aimed to analyze the epidemiologic patterns of pediatric critically-ill patients presenting to the emergency department (ED) and the etiologies of intensive care unit (ICU) admission of different age groups.

Method:

This retrospective study of all children aged less than 18 years presenting with critical illnesses to the ED was conducted in a tertiary medical center in Taiwan from 2003 to 2007. All patients transferred to the ICU from the ED were included without distinction. Demographic data of critically-ill children admitted to the ED and ICU were analyzed. Etiologies of the ICU admissions were analyzed by various age groups.

Results:

There were 2978 critically-ill children admitted to the ICU from the ED. In 120 pediatric patients with out-of-hospital cardiac arrest, cases with pulseless electrical activity or ventricular fibrillation had higher successful CPR rates than patients with asystole (both p<0.05). In patients admitted to ICUs, complications from the perinatal period, respiratory system diseases, accidental injuries and poisoning were the predominant etiologies respectively in young children (42.5%), school-aged children (38.5%), and adolescents (47.9%). Moreover, the most common of which was respiratory distress syndrome in neonates followed by bacterial pneumonia and status epilepticus.

Conclusions:

Epidemiologic analysis may provide primary clinicians to identify significant differences in admission rates based on different etiologies of various age groups.

Zusammenfassung

Hintergrund:

Das Ziel dieser Studie war die Analyse der epidemiologischen Muster von schwerkranken pädiatrischen Patienten, die in die Notfallaufnahme (ED) kamen, sowie die Untersuchung der Krankheitsursachen in den verschiedenen Altersgruppen bei Weiterleitung in die Intensivstation (ICU).

Methode:

Diese retrospektive Studie an allen Kindern unter 18 Jahren, die aufgrund kritischer Erkrankungen in die Notaufnahme aufgenommen wurden, führte ein tertiäres medizinisches Zentrum in Taiwan von 2003 bis 2007 durch. Ohne Unterschied wurden alle Patienten mit Weiterleitung von der ED zur ICU eingeschlossen. Es erfolgte die Auswertung der demografischen Daten der schwerkranken Kinder mit Aufnahme in ED und ICU. Die Krankheitsursachen bei den ICU-Aufnahmen wurden nach verschiedenen Altersgruppen ausgewertet.

Ergebnisse:

Es wurden 2 978 schwerkranke Kinder von der ED an die ICU überwiesen. Von 120 pädiatrischen Patienten mit präklinischem Herzstillstand hatten diejenigen mit pulsloser elektrischer Aktivi­tät oder Kammerflimmern höhere erfolgreiche Herz-Lungen-Wiederbelebungsraten (CPR) als solche mit Asystolie (jeweils p<0,05). Bei Patienten mit Überweisung zur ICU waren die jeweils vor­wiegenden Ätiologien in der Gruppe der Kleinkin­der Komplikationen aus der perinatalen Periode (42,5%), bei Kindern im Schulalter Erkrankungen der Atmungssysteme (38,5%) und bei Jugendlichen Unfallverletzungen und Vergiftungen (47,9%). Darüber hinaus war bei Neugeborenen am häufigsten das Atemnotsyndrom die Ursache, gefolgt von bakteriellen Pneumonien und Status epilepticus.

Schlussfolgerungen:

Die epidemiologische Aus­wertung ermöglichen dem Kliniker, die signifikanten Unterschiede bei den Aufnahmeraten zu erkennen, die auf die unterschiedlichen Krankheits­ursachen in den verschiedenen Altersgruppen zurückzuführen sind.

Key words

epidemiology - critical - OHCA - intensive care unit

Schlüsselwörter

Epidemiologie - kritisch - präklinischer Herzstillstand - Intensivstation

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