J Clin Neurol.  2019 Apr;15(2):191-204. 10.3988/jcn.2019.15.2.191.

Transient and Adult Patients with Neurologic Diseases in the Pediatric Emergency Department: Trends and Characteristics

• Na JH
• Lee YM

• KMID: 2467733
• DOI: http://doi.org/10.3988/jcn.2019.15.2.191

Abstract

BACKGROUND AND PURPOSE
There is an increasing rate of presentations by transient and adult patients (TAPs) to pediatric emergency departments (PED-EDs). TAPs with neurologic diseases (N-TAPs) comprise most of these patients. We investigated this trend and compared the characteristics of N-TAPs with those of pediatric patients with neurologic diseases (N-PEDs) who presented to the PED-ED of a tertiary-care hospital in Korea.
METHODS
We reviewed the medical records of neurologic patients who presented to the PED-ED of a single tertiary-care hospital from 2013 to 2017. We included patients with neurologic symptoms or diseases and those who were treated in the pediatric neurology department and underwent neurologic evaluations and treatment in the PED-ED.
RESULTS
Presentations by N-TAPs to the PED-ED increased over time, whereas the number of N-PEDs gradually decreased, with a significant difference between the groups (p<0.001). The number of N-TAPs who presented to the PED-ED almost tripled from 2013 to 2017. N-TAPs had significantly more acute symptoms than N-PEDs, and a significantly higher proportion of N-TAPs were insured by Medical Aid compared to N-PEDs (p<0.001). The admission rate was significantly higher (p<0.001) and the mean hospital stay was longer (p=0.046) for N-TAPs. Epilepsy and neurometabolic diseases were mainly responsible for the increased presentations by N-TAPs.
CONCLUSIONS
We have clarified the status of N-TAPs in the PED-ER and the role of pediatric neurologists who manage them. Multidisciplinary treatments focusing on the role of pediatric neurologists should be developed to that systematic long-term care plans are applied to N-TAPs.

Keyword

transient; pediatrics; adult; emergency department; neurologic patient; pediatric neurology

MeSH Terms

Adult*
Emergencies*
Emergency Service, Hospital*
Epilepsy
Humans
Korea
Length of Stay
Long-Term Care
Medical Records
Neurologic Manifestations
Neurology
Pediatrics

Figure

• 

  Fig. 1 Changing rates of N-TAPs and N-PEDs presenting to the PED-ED. Yearly changes in the numbers of N-TAPs, N-PEDs, neurologic patients, and total patients in the PED-ED. A: The number of N-TAPs steadily increased, and the proportion of N-TAPs presenting to the PED-ED more than quadrupled from 2013 to 2017. B: Unlike N-TAPs, the proportion of N-PEDs presenting to the PED-ED is steadily declining. C: Yearly changes in neurologic patients presenting to the PED-ED (both N-TAPs and N-PEDs). Neurologic patients presenting to the PED-ED show a gradually declining trend. D: Annual change in total patients presenting to the PED-ED. The total number of PED-ED patients is declining. N-PEDs: pediatric patients with neurologic diseases, N-TAPs: transient and adult patients with neurologic diseases, PED-ED: pediatric emergency department.

• 

  Fig. 2 Difference in severity levels (KTAS scores) between N-TAPs and N-PEDs. Comparison of the severity of disease in N-TAPs and N-PEDs based on KTAS scores. A: Severity distribution for N-TAPs presenting to the PED-ED. B: Severity distribution for N-TAPs presenting to the PED-ED. Overall, the N-TAPs presenting to the PED-ED had a higher severity level. The distributions in (A) and (B) were statistically significant. KTAS: Korean Triage and Acuity Scale, N-PEDs: pediatric patients with neurologic diseases, N-TAPs: transient and adult patients with neurologic diseases, PED-ED: pediatric emergency department.

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