Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):297-305. 10.5223/pghn.2018.21.4.297.

Epidemiology of Hyperbilirubinemia in a Quaternary Pediatric Emergency Department over a Three-Year Period

• Timmons Z
• Timmons J
• Conrad C
• Miloh T

• KMID: 2421992
• DOI: http://doi.org/10.5223/pghn.2018.21.4.297

Abstract

PURPOSE
There is a lack of scholarly reports on pediatric emergency department (PED) exposure to hyperbilirubinemia. We aimed to describe the epidemiology of hyperbilirubinemia in patients presenting to a PED over a three-year period.
METHODS
This was a retrospective cohort study, completed at an urban quaternary academic PED. Patients were included if they presented to the PED from 2010 to 2012, were 0 to 18 years in age, and had an elevated serum bilirubin for age. A chart review was completed to determine the incidence of hyperbilirubinemia, etiology, diagnostic work up and prognosis. The data set was stratified into four age ranges.
RESULTS
We identified 1,534 visits where a patient was found to have hyperbilirubinemia (0.8% of all visits). In 47.7% of patients hyperbilirubinemia was determined to have arisen from an identifiable pathologic etiology (0.38% of all visits). First-time diagnosis of pathologic hyperbilirubinemia occurred in 14% of hyperbilirubinemia visits (0.11% of all visits). There were varying etiologies of hyperbilirubinemia across age groups but a male predominance in all (55.0%). 15 patients went on to have a liver transplant and 20 patients died. First-time pathologic hyperbilirubinemia patients had a mortality rate of 0.95% for their initial hospitalization.
CONCLUSION
Hyperbilirubinemia was not a common presentation to the PED and a minority of cases were pathologic in etiology. The etiologies of hyperbilirubinemia varied across each of our study age groups. A new discovery of pathologic hyperbilirubinemia and progression to liver transplant or death during the initial presentation was extremely rare.

Keyword

Hyperbilirubinemia; Pediatrics; Emergency medicine

MeSH Terms

Bilirubin
Cohort Studies
Dataset
Diagnosis
Emergencies*
Emergency Medicine
Emergency Service, Hospital*
Epidemiology*
Hospitalization
Humans
Hyperbilirubinemia*
Incidence
Liver
Male
Mortality
Pediatrics
Prognosis
Retrospective Studies
Bilirubin

Figure

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  Fig. 1 Age distribution of hyperbilirubinemia.

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