Purpose: We analyzed annual trends and clinical characteristics across the full spectrum of pediatric psychiatric emergency department (ED) visits.Methods: This retrospective study included patients aged 18 years or younger who underwent psychiatric interview at the ED of Gyeongsang National University Hospital, Jinju, South Korea, from January 2013 through December 2023. The patients were classified as per their clinical presentations: suicide attempt (SA), non-suicidal self-harm (NSSH), suicidal ideation (SI), and other psychiatric problems (OPP). Annual trend was analyzed using the simple linear regression, while group characteristics were compared using the Kruskal-Wallis and chi-square tests.Results: Of 730 patients, 688 and 465 were included for the annual trend and comparative analyses, respectively. Over the 11-year period, their psychiatric ED visits increased (P <0.001), with the most prominent increase in the SA group. A median age was 16.0 years (interquartile range, 14.0–17.0), and 69.2% of the patients were female. Although female patients predominated in all groups, the predominance was more prominent in the SA and NSSH groups. Drug ingestion (60.0%) was the most common mechanism; cutting was more frequent in the NSSH group (SA, 21.7% vs. NSSH, 49.0%; P <0.001), while highly lethal methods were more frequent in the SA group (e.g., falls: 10.1% vs. 0%; P = 0.001). Regarding psychosocial stressors, family-related factors were highest in the SA and NSSH groups (P = 0.002), social/interpersonal (P = 0.026) and academic (P = 0.044) in the NSSH group, psychosocial trauma-related in the SI group (P = 0.005), and individual/psychiatric in the OPP group (P <0.001). A median ED length of stay and hospitalization rate were longest or highest in the SA group (all Ps <0.001).Conclusion: Pediatric psychiatric patients presenting to EDs represent a heterogeneous population, and tailored intervention strategies are needed for each clinical manifestation group.
Purpose: We aimed to characterize pediatric emergency department (ED) visits for foreign body (FB) ingestion in Korea, and to identify clinical- and system-level determinants of hospitalization.Methods: We analyzed 2,870 children aged 9 years or younger who visited EDs with FB ingestion from 2019 through 2023, using the National Emergency Department Information System. Emergency facilities were classified into regional emergency medical centers (EMCs), local EMCs, and local emergency medical facilities (EMFs), in descending order of hierarchy. Regression models sequentially incorporated clinical variables and the facility type to identify hospitalization determinants. Mediation analysis quantified the role of the facility type in regional disparities. Results: Most visits involved ages of 1–4 years (55.3%) and were a Korean Triage and Acuity Scale 4–5 (76.0%), with an 8.1% overall hospitalization rate. The visits were concentrated in the capital region (i.e., Seoul, Incheon, or Gyeonggi Province), with Seoul highest (168.1 per 100,000 children). Compared with the regions, non-capital regions showed higher percentages of Korean Triage and Acuity Scale 1–3 (21.6% vs. 24.4%) and visits to local EMFs (3.9% vs. 28.6%), yet showed a lower hospitalization rate (6.7% vs. 8.9%). In a regression model, the facility type was the strongest determinant of hospitalization (compared with local EMFs: regional EMCs, adjusted odds ratio = 14.20 [95% confidence interval, 5.19–58.70]; local EMCs (8.35 [3.03–34.60]). The effect of the capital region was attenuated after adjusting for the facility type (adjusted odds ratio, from 1.76 to 1.45). Mediation analysis suggested an association of the regional disparities with the unequal distribution of EMCs. Conclusion: In pediatric FB ingestion, hospitalization is driven by regional disparities in facility access, with facility type acting as a mediator. The paradoxical lower hospitalization rate in the non-capital regions may reflect differential facility access, highlighting the need for a tiered regional strategy.
Purpose: We aimed to evaluate the agreement between caregivers’ assessment of their children’s urgency of illness and the Emergency Severity Index (ESI) assigned at triage, and to identify factors associated with the caregivers’ assessment.Methods: This prospective questionnaire-based study was performed in Department of Pediatric Emergency of Harlem Hospital Center during January–April 2021. Before physician evaluation, caregivers rated perceived urgency of their children’s conditions using a 4-level scale (evaluation ≤15 minutes, 15–59 minutes, 1–2 hours, or >2 hours). ESI levels were assigned by triage nurses. Agreement between the caregivers’ assessment and ESI levels was evaluated using intraclass correlation coefficient. Ordinal logistic regression was used to identify factors associated with the caregivers’ assessment.Results: A total of 338 caregiver surveys were analyzed. Exact agreement between the caregiver assessment and ESI occurred in 35.8% of cases, with over- and under-triage observed in 54.4% and 9.8%, respectively. The agreement was fair overall (intraclass correlation coefficient, 0.53 [95% confidence interval, 0.14–0.72]) and good among the caregivers of children with ≥4 prior visits to emergency departments (0.74 [0.16–0.92]), non-native English speakers (0.67 [0.39–0.81]), and daytime presentations (0.64 [0.25–0.80]). In a regression model, visits in the evenings (adjusted odds ratio, 0.57 [0.37–0.88]) or nights (0.32 [0.15–0.64]) and trauma-related visits (0.52 [0.30–0.90]) were associated with a higher urgency in the caregivers’ assessment. Among 15 patients hospitalized to the intensive care unit, 12 were triaged as ESI level 2 and 3 as level 3. The caregivers assessed the former 12 as requiring evaluation within 15 minutes and the latter 3 within 1 hour.Conclusion: Caregiver assessments showed fair agreement and tendency toward over-triage compared with ESI levels. Caregivers’ input may provide contextual information but should not replace structured triage systems.
Acquired methemoglobinemia is a rare and potentially lethal complication of several oxidizing agents, with ingestions reported in patients of various demographics. Here, we present a 30-month-old patient with sodium chlorite-induced methemoglobinemia that was refractory to initial intermittent infusions of methylene blue and ultimately required continuous infusion of the antidote. The hospital course was complicated by hemolytic anemia requiring blood transfusion, with eventual improvement in laboratory testing and clinical presentation.
