Emergency Department Visits In Patients Research Articles

On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial

Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.

Characteristics and Trends of Pediatric Trauma in Jeju Island, South Korea: A Community Level Serial Cross-sectional study.

This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments (EDs) on Jeju Island. Employing a community-level serial cross-sectional analysis, we targeted pediatric patients aged 18 years or younger who visited EDs for injuries over a ten-year period. The data, sourced from the Jeju Injury Surveillance System (JISS), facilitated a comprehensive examination of injury characteristics and epidemiological trends. This included an evaluation of the annual incidence and overall trends in pediatric injury cases. The study found toddlers (42.5% of cases) to be the most frequently injured age group. Males were more prone to injuries, with a male-to-female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in Summer, evenings and weekends. Most incidents occurred at home, predominantly accidental in nature, with adolescents more likely to require EMS services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized, while self-harm/suicide and assault/violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents. The study underscores the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and times, to effectively mitigate pediatric trauma on Jeju Island.

The skåne emergency medicine (SEM) cohort

BackgroundIn the European Union alone, more than 100 million people present to the emergency department (ED) each year, and this has increased steadily year-on-year by 2–3%. Better patient management decisions have the potential to reduce ED crowding, the number of diagnostic tests, the use of inpatient beds, and healthcare costs.MethodsWe have established the Skåne Emergency Medicine (SEM) cohort for developing clinical decision support systems (CDSS) based on artificial intelligence or machine learning as well as traditional statistical methods. The SEM cohort consists of 325 539 unselected unique patients with 630 275 visits from January 1st, 2017 to December 31st, 2018 at eight EDs in the region Skåne in southern Sweden. Data on sociodemographics, previous diseases and current medication are available for each ED patient visit, as well as their chief complaint, test results, disposition and the outcome in the form of subsequent diagnoses, treatments, healthcare costs and mortality within a follow-up period of at least 30 days, and up to 3 years.DiscussionThe SEM cohort provides a platform for CDSS research, and we welcome collaboration. In addition, SEM’s large amount of real-world patient data with almost complete short-term follow-up will allow research in epidemiology, patient management, diagnostics, prognostics, ED crowding, resource allocation, and social medicine.

Changes in epidemiology of patients visiting emergency departments during the early COVID-19 pandemic period

Infectious disease outbreaks have a great influence on the use of emergency departments (EDs). The purpose of this study was to analyze the effect of the early coronavirus disease outbreak (COVID-19) on ED visits, to be able to more effectively use ED resources during infectious disease outbreaks. This was a retrospective observational study conducted in three tertiary EDs. We defined the COVID-19 period as 01 December 2019, to 30 April 2020, and the control periods were defined as the same period in 2018 and 2019. All patients who visited the EDs during the study period were included. We collected visitor data on the total number, demographics, clinical data, vital signs, acuity level, cause of visit, disposition, time of visit and diagnostic code. A total of 180,192 patients were enrolled in this study. During the COVID-19 period, the number of ED visits decreased significantly. This decline was significant since mid-February when the number of COVID-19 patients surged nationwide. The proportion of critical patients and admission rate increased while the proportion of non-emergency patients decreased significantly from February (p < 0.001). The proportion of night-time ED visits decreased significantly from March. During the COVID-19 period and pre-COVID-19 period, the top three diagnosis areas were “abdominal and pelvis pain” “fever of other and unknown origin” and “open wound in the head” and remained unchanged. “Influenza because of an identified seasonal influenza virus” decreased during the study period. The study showed the number and characteristics of ED visits changed during the COVID-19 period compared with those of pre-COVID-19 periods.

Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic.

Unscheduled low-acuity care options are on the rise and are often expected to reduce emergency department (ED) visits. We opened an ED-staffed walk-in clinic (WIC) as an alternative care location for low-acuity patients at a time when ED visits exceeded facility capacity and the impending flu season was anticipated to increase visits further, and we assessed whether low-acuity ED patient visits decreased after opening the WIC. In this retrospective cohort study, we compared patient and clinical visit characteristics of the ED and WIC patients and conducted interrupted time-series analyses to quantify the impact of the WIC on low-acuity ED patient visit volume and the trend. There were 27,211 low-acuity ED visits (22.7% of total ED visits), and 7,058 patients seen in the WIC from February 26, 2018, to November 17, 2019. Low-acuity patient visits in the ED reduced significantly immediately after the WIC opened (P=0.01). In the subsequent months, however, patient volume trended back to pre-WIC volumes such that there was no significant impact at 6, 9, or 12 months (P=0.07). Had WIC patients been seen in the main ED, low-acuity volume would have been 27% of the total volume rather than the 22.7% that was observed. The WIC did not result in a sustained reduction in low-acuity patients in the main ED. However, it enabled emergency staff to see low-acuity patients in a lower resource setting during times when ED capacity was limited.

Artículo traducido] Errores de medicación en niños que acuden a los servicios de urgencias pediátricas

ObjectivesMedication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. MethodsWe conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. ResultsIn 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were “medication knowledge deficit” (63.8%), “deviation from procedures/guidelines” (48.6%) and “lack of patient information” (30.3%). ConclusionsMedication errors presented by children attending emergency departments arise from prescriptions, self-medication, and administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.

Emergency Department Patient Satisfaction Survey in a Tertiary Care Hospital of Eastern Nepal

Background: Patient satisfaction is one of the most important indicators of the quality of emergency care. This hospital-based cross-sectional study was performed to assess patient satisfaction in the Emergency department of a tertiary care hospital and identify the factors associated. Methods: The study was performed on 785 patients visiting Emergency department. Variables under study were satisfaction level, triage score, waiting times, and socio-demographic characteristics. Satisfaction level was measured using a 5-point Likert scale, Cronbach’s alpha (α= 0.86 overall, inter-item α = 0.842-0.859). A score of 47 and above was cut off to denote satisfaction with a sensitivity of 75% and specificity of 81%. Descriptive analysis and Chi-square test was performed to see the association of variables of interests with patient satisfaction. A p-value <0.05 was considered statistically significant. Results: Median age of the patients was 47 years among which 51% were male. Medical emergencies were the most common problems reported (68.7%). The median (Q1, Q3, maximum) time to first contact with the doctor was 10 (5,15, 240) minutes. The patient satisfaction rate towards the Emergency services was 69%. Behavior of doctors (54%) and nurses’ care (44%) were rated as excellent services while poorer ratings were given for toilet condition (27%) and crowd control (14%). Weekends vs weekdays had a significant association with satisfaction (p = 0.04). Conclusion: Overall acceptable patient satisfaction rate was found in the services provided by the Emergency department. Areas needing improvement were identified.

A practical approach for small bowel bleeding.

Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.

Medication errors in children visiting pediatric emergency departments

ObjectivesMedication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. MethodsWe conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. ResultsIn 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were “medication knowledge deficit” (63.8%), “deviation from procedures/guidelines” (48.6%) and “lack of patient information” (30.3%). ConclusionsMedication errors presented by children attending emergency departments arise from prescriptions, self-medicationand administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.

Hand Injury among Patients Visiting Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study

The hand is a complex organ responsible for activities of daily living, making it susceptible to injuries and accidents. Hand injuries can result in significant functional impairment and it occurs in a younger productive age group. Therefore, it is important to understand the prevalence and patterns of hand injuries. The aim of the study was to find out the prevalence of hand injuries among patients visiting the emergency department of a tertiary care centre. A descriptive cross-sectional study was in the Emergency Department of a dedicated trauma centre from 1June 2022 to 31 August 2022. Ethical approval was obtained from the Institutional Review Board (Reference number: 148412078179). Demographic profile, pattern, and mechanism of hand Injuries of all 96 consecutive patients were assessed after taking informed consent. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 4679 patients visiting the emergency department of the trauma centre, hand injuries were seen in 96 (2.05 %) (1.64-2.46, 95% Confidence Interval). The prevalence of hand injuries was found to be lower than in other similar studies done in similar settings. finger injuries; hand injuries; occupational injuries.

Modified Shock Index as a Predictor of Admission and In-hospital Mortality in Emergency Departments; an Analysis of a US National Database.

The modified shock index (MSI) is the ratio of heart rate to mean arterial pressure. It is used as a predictive and prognostic marker in a variety of disease states.This study aimed to derive the optimal MSI cut-off that is associated with increased likelihood (likelihood ratio, LR) of admission and in-hospital mortality in patients presenting to emergency department (ED). We retrospectively reviewed data from the National Hospital Ambulatory Medical Care Survey between 2005 and 2010. Adults>18 years of age were included regardless of chief complaint. Basic patient demographics, initial vital signs, and outcomes were recorded for each patient. Then the optimal MSI cut-off for prediction of admission and in-hospital mortality in ED was calculated. LR ≥ 5 was considered clinically significant. 567,994,402 distinct weighted adult ED patient visits were included in the analysis. 15.7% and 2.4% resulted in admissions and in-hospital mortality, respectively. MSI > 1.7 was associated with a moderate increase in the likelihood of both admission (Positive LR (+LR) = 6.29) and in-hospital mortality (+LR = 5.12). +LR for hospital admission at MSI >1.7 was higher for men (7.13; 95% CI 7.11-7.15) compared to women (5.49; 95% CI 5.47-5.50) and for non-white (7.92; 95% CI 7.88-7.95) compared to white patients (5.85; 95% CI 5.84-5.86). For MSI <0.7, the +LRs were not clinically significant for admission (+LR = 1.07) or in-hospital mortality (LR = 0.75). In this largest retrospective study, to date, on MSI in the undifferentiated ED population, we demonstrated that an MSI >1.7 on presentation is predictive of admission and in-hospital mortality. The use of MSI could help guide accurate acuity designation, resource allocation, and disposition.

Characteristics of poisoning patients visiting emergency departments before and after the COVID-19 pandemic

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Monocyte distribution width as a pragmatic screen for SARS-CoV-2 or influenza infection

Monocyte distribution width (MDW) is a novel marker of monocyte activation, which is known to occur in the immune response to viral pathogens. Our objective was to determine the performance of MDW and other leukocyte parameters as screening tests for SARS-CoV-2 and influenza infection. This was a prospective cohort analysis of adult patients who underwent complete blood count (CBC) and SARS-CoV-2 or influenza testing in an Emergency Department (ED) between January 2020 and July 2021. The primary outcome was SARS-CoV-2 or influenza infection. Secondary outcomes were measures of severity of illness including inpatient hospitalization, critical care admission, hospital lengths of stay and mortality. Descriptive statistics and test performance measures were evaluated for monocyte percentage, MDW, white blood cell (WBC) count, and neutrophil to lymphocyte ratio (NLR). 3,425 ED patient visits were included. SARS-CoV-2 testing was performed during 1,922 visits with a positivity rate of 5.4%; influenza testing was performed during 2,090 with a positivity rate of 2.3%. MDW was elevated in patients with SARS-Cov-2 (median 23.0U; IQR 20.5–25.1) or influenza (median 24.1U; IQR 22.0–26.9) infection, as compared to those without (18.9U; IQR 17.4–20.7 and 19.1U; 17.4–21, respectively, P < 0.001). Monocyte percentage, WBC and NLR values were within normal range in patients testing positive for either virus. MDW identified SARS-CoV-2 and influenza positive patients with an area under the curve (AUC) of 0.83 (95% CI 0.79–0.86) and 0.83 (95% CI 0.77–0.88), respectively. At the accepted cut-off value of 20U for MDW, sensitivities were 83.7% (95% CI 76.5–90.8%) for SARS-CoV-2 and 89.6% (95% CI 80.9–98.2%) for influenza, compared to sensitivities below 45% for monocyte percentage, WBC and NLR. MDW negative predictive values were 98.6% (95% CI 98.0–99.3%) and 99.6% (95% CI 99.3–100.0%) respectively for SARS-CoV-2 and influenza. Monocyte Distribution Width (MDW), available as part of a routine complete blood count (CBC) with differential, may be a useful indicator of SARS-CoV-2 or influenza infection.

Improving care for older patients visiting emergency departments. Are they receiving falls prevention guideline care?

BackgroundThe primary objective was to examine whether the Emergency Department (ED) treatment of older adults who fall in Australia is concordant with falls prevention and management clinical guideline care recommendations. MethodsA retrospective medical records audit was completed for patients 65years and older, who attended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines. ResultsOne thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p < 0.001) in an observation ward (p < 0.001). ConclusionsOlder patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur.

P147 Interaction effects between covid-19 outbreak and community income levels on excess mortality among patients visiting emergency department

P147 Interaction effects between covid-19 outbreak and community income levels on excess mortality among patients visiting emergency department

Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care.

To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits. Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care. Participants included 14 older adult patients ( 65years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers. We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering. Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.

Precipitating Factors Predict Length of Stay More Than 1 Day in Acute Decompensated Heart Failure Patients Visiting Emergency Department

Background: Patients with acute decompensated heart failure have different precipitating factors. Therefore, there will be a different length of hospital stays. Methods: A retrospective cohort study collected data of acute decompensated heart failure patients who were not dead and not inserted an endotracheal tube in the first 6 hours who came to the emergency department of Ramathibodi Hospital during 2016 to 2017. Collected data from the characteristics of patients, underlying diseases, medical signs, vital signs and laboratory in the emergency department, and factors stimulating acute decompensated heart failure in patients. Logistic regressions were used for data analysis. Results: Of all 213 patients, 151 patients stayed in the hospital for more than 1 day and 62 patients in less than 1 day. Precipitating factors that predict more than 1 day of hospital stay are arrhythmia and acute coronary syndrome. Precipitating factor that predicts less than 1 day of hospital stay is noncompliance with medications. After adjusting by sex, age, comorbid, and NYHA class, precipitating factors that predict more than 1 day of hospital stay is an arrhythmia (OR, 7.46; 95% CI, 2.09 - 26.60). Conclusions: Patients who precipitate acute decompensated heart failure by arrhythmia have probably more than 1 day of hospital stay. In the case of hospital bed limit, this group of patients should be considered as inpatients.

Prevalence and predictors of drug-related hospitalisation among patients visiting emergency departments of Addis Ababa city hospitals in Ethiopia: a multicentre prospective observational study

ObjectivesThis study aimed to determine the prevalence, categories and predictors of drug-related hospitalisation (DRH) among patients visiting emergency departments of Addis Ababa city hospitals, Ethiopia.DesignA multicentre prospective observational study was...

The impact of COVID-19 on the patterns of emergency department visits among pediatric patients

ObjectivesThis study aimed to investigate the patterns of pediatric patients visiting emergency departments (EDs) before and after the COVID-19 pandemic and evaluate the interactive effect between the COVID-19 outbreak and age groups. MethodsWe performed a cross-sectional study using the nationwide emergency patient database in Korea from January 2019 to December 2020. Pediatric patients (≤18 years) who visited all 402 nationwide EDs were included. The age- and sex-standardized incidence rates of pediatric ED visits per 1,000,000 person-days were calculated, and the incidence rate ratio (IRR) was calculated. The adjusted odds ratio (aOR) and 95% confidence interval (CI) of in-hospital mortality were calculated by a multivariable logistic regression. ResultsAmong 2,808,756 patients, 1,835,045 (65.3%) patients visited before COVID-19, and 973,711 (34.7%) patients visited after the COVID-19 period. The standardized incidence rates of ED visits per 1,000,000 person-days were 589.3 in the before COVID-19 group and 326.9 in the after COVID-19 group (IRR (95% CI): 0.55 (0.53–0.58)). By diagnosis, the IRRs (95% CI) of mental health disorders (0.84 (0.42–1.65)) and self-harm or suicidal attempts (0.99 (0.38–2.59) were not significant, while the incidence rate of infectious disease was significantly decreased (0.48 (0.42–0.54)). The aOR (95% CI) of in-hospital mortality after COVID-19 was 1.58 (1.44–1.73) compared to that before COVID-19. ConclusionsDuring the COVID-19 pandemic, the incidence of pediatric ED visits decreased, and these effects differed by age group. Age-specific policies are needed to ensure that children receive the care they need at the right time.

A Machine Learning-Based Study of the Effects of Air Pollution and Weather in Respiratory Disease Patients Visiting Emergency Departments.

Background To date, investigating respiratory disease patients visiting the emergency departments related with fined dust is limited. This study aimed to analyze the effects of two variable-weather and air pollution on respiratory disease patients who visited emergency departments. Methods This study utilized the National Emergency Department Information System (NEDIS) database. The meteorological data were obtained from the National Climate Data Service. Each weather factor reflected the accumulated data of 4 days: a patient's visit day and 3 days before the visit day. We utilized the RandomForestRegressor of scikit-learn for data analysis. Result The study included 525,579 participants. This study found that multiple variables of weather and air pollution influenced the respiratory diseases of patients who visited emergency departments. Most of the respiratory disease patients had acute upper respiratory infections [J00–J06], influenza [J09–J11], and pneumonia [J12–J18], on which PM10 following temperature and steam pressure was the most influential. As the top three leading causes of admission to the emergency department, pneumonia [J12–J18], acute upper respiratory infections [J00–J06], and chronic lower respiratory diseases [J40–J47] were highly influenced by PM10. Conclusion Most of the respiratory patients visiting EDs were diagnosed with acute upper respiratory infections, influenza, and pneumonia. Following temperature, steam pressure and PM10 had influential relations with these diseases. It is expected that the number of respiratory disease patients visiting the emergency departments will increase by day 3 when the steam pressure and temperature values are low, and the variables of air pollution are high. The number of respiratory disease patients visiting the emergency departments will increase by day 3 when the steam pressure and temperature values are low, and the variables of air pollution are high.