Abstract
Transmission risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in schools is unknown. Our investigations, especially in preschools, could not detect SARS-CoV-2 ...transmission despite screening of symptomatic and asymptomatic children. The data suggest that children are not the primary drivers of SARS-CoV-2 transmission in schools and could help inform exit strategies for lifting of lockdowns.
Knowledge of transmission dynamics of severe acute respiratory syndrome coronavirus 2 from adults to children in household settings is limited. We found an attack rate among 213 children in 137 ...households to be 6.1% in households with confirmed adult 2019 novel coronavirus disease index case(s). Transmission from adult to child occurred in only 5.2% of households. Young children <5 years old were at lowest risk of infection (1.3%). Children were most likely to be infected if the household index case was the mother.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Febrile infants ≤ 90 days old make up a significant proportion of patients seeking care in the emergency department (ED). These infants are vulnerable to serious bacterial infections (SBIs) and early ...identification is required to initiate timely investigations and interventions. We aimed to study if height of an infant's temperature on presentation to the ED is associated with SBI.
We performed a retrospective chart review on febrile infants ≤ 90 days old presenting to our ED between 31
March 2015 and 28
February 2016. We compared triage temperature of febrile infants with and without SBIs. We presented sensitivity, specificity, positive and negative predictive values (PPV and NPV) of fever thresholds at triage. A multivariable regression was performed to study the association between height of temperature and the presence of SBI, and presented the adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI).
Among 1057 febrile infants analysed, 207 (19.6%) had a SBI. Mean temperature of infants with a SBI was significantly higher than those without (mean 38.5 °C, standard deviation, SD 0.6 vs. 38.3 °C, SD 0.5, p < 0.005). For temperature ≥ 39 °C, sensitivity, specificity, PPV and NPV for SBI was 15.5% (95%CI 10.8-21.1%), 90.4% (95%CI 88.2-92.3%), 28.1% (95%CI 21.1-36.3%) and 81.4% (95%CI 80.5-82.4%) respectively. The height of fever was consistently associated with SBI after adjusting for age, gender and SIS (aOR 1.76, 95% CI 1.32-2.33, p < 0.001). However, 32 (15.5%) infants with SBIs had an initial triage temperature ≤ 38 °C.
A higher temperature at triage was associated with a higher risk of SBI among febrile infants ≤ 90 days old. However, height of temperature must be used in conjunction with other risk factors to identify SBIs in young infants.
Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services ...including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore.
We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs).
We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change - 87.9, 95% CI - 89.3 to - 86.3, p < 0.001) and gastrointestinal infections (% change - 72.4, 95%CI - 75.9 to - 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change - 40.0, 95%CI - 44.3 to - 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change - 73.9, 95%CI - 75.9 to - 71.7, p < 0.001).
We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.
Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy ...versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician's diagnosis. The chosen model is a bidirectional long-short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs-healthy or pathology (in general or belonging to a specific respiratory pathology)-reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians' diagnosis. To classify the subject's respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Pediatric patients present to Emergency Departments (EDs) with a variety of medical conditions. An appreciation of the common presenting conditions can aid EDs in the provision of pediatric emergency ...care. In this study, we established the common pediatric diagnoses seen at the general EDs, with reference to a pediatric ED.
A retrospective review of medical records was performed for patients less than 16 years old at a pediatric ED and two general EDs from 1 January to 31 December 2018. Information including patient demographics, triage category, case type and diagnoses were collected.
There were 159,040 pediatric attendances, of which 3477 (2.2%) were seen at the general EDs. Non-traumatic conditions were most prevalent at both general (N = 1933, 55.6%) and pediatric (N = 128,415, 82.5%) EDs. There was a higher proportion of trauma related conditions seen at the general EDs (N = 1544, 44.4%) compared to the pediatric ED (N = 27,148, 17.5%; p < 0.01). Across all EDs, upper respiratory tract infection, unspecified musculoskeletal pain and gastroenteritis were the three most common non-trauma related diagnoses, while fracture, wound and contusion were the three most common trauma related diagnoses. There was a greater proportion of emergent (P1) cases seen at the general EDs (N = 233, 6.7%) than the pediatric ED (N = 3821, 2.5%; p < 0.01). Respiratory conditions including bronchiolitis, asthma and bronchitis were the most common emergent (P1) diagnoses.
The common diagnoses among pediatric attendances varied between pediatric and general EDs. Therefore, general EDs should focus their efforts on these common diagnoses, especially the emergent (P1) ones, so that they can enhance their preparedness and work towards providing quality pediatric emergency care.
BackgroundMedication errors (MEs) are a significant cause of preventable morbidity and mortality. The paediatric emergency department (ED) is a high-risk setting with high patient volume and acuity ...of care, serving a uniquely susceptible population where weight-based calculations render them vulnerable to dosing errors. Medications are also often kept in stock, and are not audited by a pharmacist prior to administration. Stress, noise, time pressures, and unfamiliarity with paediatric conditions amongst rotating trainees compound this risk.ObjectivesTo describe the occurrence and type of MEs in pediatric ED and to identify contributing factors.MethodsA retrospective review of all reported MEs in Singapore’s largest tertiary pediatric ED from January 2013 to December 2019. MEs were reported via Risk Management System (RMS), while near-misses were extracted from RMS and the pharmacy department’s Closed Loop Medication Management System. Descriptive statistics were used to present ME types, severity and contributing factors.ResultsOf 101 MEs reported in RMS, 59% were related to wrong dose, 22% to wrong medication and 6% to wrong patient. Wrong doses were related to duplicate dose (48%), wrong weight (20%), 10-fold errors (5%) and calculation errors (5%). Majority of MEs occurred during drug administration (52%), followed by prescription (30%) and transcription of medications (12%). Most commonly involved medications in MEs were anti-pyretics (33%), those for respiratory conditions (15%) and analgesics (13%). Of the MEs, 9 (9%) were serious errors requiring enhanced monitoring and/or intervention, while 1 (1%) caused temporary patient harm. Human factors (92%) was the most frequently documented contributing factor, namely failure to comply with established workflows, accurate information provided by guardians, and distractions.ConclusionsWe have described a low incidence of MEs from 2013 to 2019. Strategies should be developed to ameliorate MEs in the pediatric ED. Areas for focused intervention should include systematic evaluation of drug administration and prescription processes, to enhance compliance with established procedures of checking (amongst the healthcare team and with guardians) and putting safeguards in place to minimize the impact of distractions in the ED setting.
There remains controversy in the management of Gartland Type II fractures. This study reviews the outcome and significance of stability parameters in deciding fracture stability for Gartland Type II ...fractures and hence suitability for conservative treatment.
This is a retrospective observational cohort study involving children presenting to the Emergency Department between January and October 2017 with a diagnosis of supracondylar humerus fractures (SCHF). We obtained 142 patients (34 operative and 108 non-operative), recording their demographics, circumstances of injury, and X-ray findings for those with Gartland Type II extension type SCHF. Radiological outcomes were assessed using the anterior humeral line and Baumann's angle. We also assessed the fracture characteristic which may contribute to instability. Data were analysed using SPSS Statistics Version 26.
We analysed 142 children with a mean age of 5.7 years old (SD ± 2.5). Significant parameters included: breach of anterior cortex, presence of medial comminution and disruption of the hourglass configuration (p = 0.001, p<0.001, and p = 0.004 respectively). There was no difference in malunion, defined using either an abnormal anterior humeral line (11/34 or 32.4% vs 45/108 or 41.7%, p = 0.422) or the Baumann's angle (mean angle 75.2° vs 73.9°, p = 0.244).
Subclassification of Gartland extension-type II paediatric humerus supracondylar fracture using additional characteristics of breach of anterior cortex, presence of medial comminution and disruption of the hourglass allows a more accurate assessment of fracture stability. Hence avoiding and minimising unnecessary surgery.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To assess the inter-rater reliability of the modified Gartland classification together with other radiological parameters for extension type supracondylar humerus fractures (SCHF) in children.
A ...retrospective cohort study was conducted at a tertiary children's hospital in Singapore on children less than 12 years old with a diagnosis of extension-type SCHF between January 2017 and October 2017. Anteroposterior and lateral radiographs were assessed by fellowship-trained radiologist and orthopaedic surgeon. The radiographs were assessed for any breach of anterior cortex, breach of posterior cortex, presence of medial comminution, disrupted hourglass configuration and abnormal Baumann's angle. CorrespondingCohen's κ values were used to assess the level of inter-rater agreement.
We found an inter-rater agreement for the modified Gartland classification of κ = 0.141 (95 % CI, 0.049 to 0.233). Inter-rater agreement was κ = 0.654 (95 % CI, 0.493–0.815) for assessing a breach of anterior cortex was, κ = 0.357 (95 % CI, 0.135–0.578) for Baumann's angle, κ = 0.317 (95 % CI, 0.145–0.488) for a disrupted hourglass configuration, κ = 0.271 (95 % CI, 0.105–0.437) for a breach of posterior cortex and κ = 0.131 (95 % CI, −0.127 – 0.389) for the presence of medial comminution.
We found a low inter-rater reliability for the modified Gartland classification. The breach of anterior and posterior cortex, Baumann's angle and hourglass disruption have higher inter-rater reliability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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