ICNC Abstracts, ICNC 2018

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Emergency room visits and admission rates of children with neuromuscular disorders: A 10-year experience in a medical center in Taiwan
Tai-Heng Chen, Yao-Hua Liu, Wei-Tsun Kao, Yung-Hao Tseng

Last modified: 2018-09-09

Abstract


Background: We aimed to determine the major reasons for the emergency room (ER) readmission of pediatric patients with chronic neuromuscular disorders (NMDs), and suggest changes to the care plan to decrease readmissions.

Methods: Children with chronic NMDs (aged <18 years) who visited a medical center-based ER between January 2005 and January 2015 were included. Data including presentations; demographic data, including sex and age; NMD diagnosis; triage classification; emergency examination; initial management; and outcomes were extracted from the patient’s ER records. The outcomes were death inside or outside the ER, admission to the ward or pediatric intensive care unit (PICU), uneventful discharge, and repeated ER visits.

Results: 44 children with heterogeneous NMDs (mean age: 9.9 years) visited the ER for an accumulated 204 times. Repeated ER visits and readmissions occurred in 56.7% and 55.6% of the patients, respectively. Most of the NMD children belonged to triage class 3 (35.3%), with underlying congenital hereditary muscular dystrophy (44.1%). The major symptoms were usually multiple and concurrent, and primarily respiratory (62.3%) or gastrointestinal (28.9%). The most common causes of hospitalization were pneumonia (48.5%) or acute gastritis (20.4%), and approximately half of the ER visits required further hospitalization, of which 28.2% involved PICU admission. Although respiratory compromise caused most of the ER visits and admissions, pulmonary assessments, including chest films (28%), pulse oximetry (15%), and blood gas analysis (11%), were performed in a relatively small proportion.

Conclusion: The ER staff must recognize patients’ unmet needs for respiratory and gastrointestinal care related to underlying NMDs.


Keywords


neuromuscular disorders; emergency care; admission rate

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