Chu-Chung Chou

Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest

AIM OF THE STUDY Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge. METHODS We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20 min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed. RESULTS Among the 80 children who achieved sustained ROSC for at least 20 min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale=1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm (p=0.012), normal heart rate (p=0.008), normal blood pressure (p<0.001), urine output>1 ml/kg/h (p=0.002), normal skin color (p=0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture (p=0.044), initial Glasgow Coma Scale score>7 (p<0.001), and duration of in-hospital CPR<or=10 min (p<0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p<0.05). CONCLUSIONS The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output>1 ml/kg/h.

First Attack of Acute Urticaria in Pediatric Emergency Department

BACKGROUND Management of a first attack of acute urticaria in children is dependent on the etiology of the disease. Knowledge of the various etiologies of urticaria will help primary physicians to perform appropriate clinical assessments. In this study, we analyzed the etiologies and their prevalence in first-attack acute urticaria in infants, children and adolescents in central Taiwan. METHODS This was a retrospective study of 953 children who were admitted to the emergency department (ED) with a first attack of acute urticaria from January 2000 to December 2006. All patients were followed in the ED or outpatient department until their symptoms subsided. Patient demographics and detailed etiologies of the first attack of acute urticaria were analyzed. Furthermore, the prevalence of various etiologies in different age groups, as well as the etiologic trends of acute urticaria in children during the previous 7 years, was determined. RESULTS The most common etiologies of a first attack of acute urticaria in children were various infections (48.4%), foods (23.5%), idiopathic causes (13.2%), and medications (11.5%). Among the three major etiologies above, upper respiratory tract infections (nasopharyngitis), seafood (shrimp) and nonsteroidal anti-inflammatory drugs (ibuprofen) were the most frequent causes. Moreover, the etiologies differed significantly with patient age (p < 0.001). Overall, infections were the major cause in infants (56.5%), whereas food (36.6%) and medications (26.8%) were the most common etiologies in adolescents. The prevalence of various infections dropped as the age of the children increased (56.5% in infants, 51.2% in preschool-aged children, 42.1% in school-aged children and 17.1% in adolescents). The etiologies of foods and medications were more prevalent in adolescents than in younger children. CONCLUSION Detailed etiologies of first-attack urticaria in children in central Taiwan were analyzed. Most importantly, we found that there was a decrease in the prevalence of various infections as causative factors as the age of the children increased. The etiologies of foods and medications were more prevalent in adolescents than in younger children.

Poison exposure and outcome of children admitted to a pediatric emergency department

BackgroundThis paper reports the characteristics, outcomes and clinical features of children with poisoning treated at an emergency department (ED).MethodsThis retrospective study at an emergency department consisted of 140 children with poison exposure who were aged under 18 years. Their characteristics were analyzed in order to understand the differences between accidental and non-accidental poisoning. The poisonous materials were divided into two major categories (pharmaceuticals and non-pharmaceuticals) and their associations with patient outcomes were analyzed. Furthermore, the association was analyzed between the incidence of poison exposure and the season in which the poison exposure occurred.ResultsThe incidence of poison exposure was highest among adolescents and pre-school age children. Nonaccidental poisoning was more common in older girls and accidental poisoning was more common in younger boys (P<0.001). Neurological system agents were the most common cause of poisoning in the pharmaceutical group and cleansing products were the most common cause of poisoning in the non-pharmaceutical group. Neurological and gastrointestinal symptoms were the most common clinical presentations for the pharmaceutical and non-pharmaceutical groups, respectively. Furthermore, poisoning due to cleansing products and analgesics were associated with the longest duration of hospitalization. March was the highest risk month for pediatric poisoning (P=0.018).ConclusionsCleansing products and analgesics were associated with the longest duration of hospitalization and intentional poison was more common in girls.

Pharmaceutical Poisoning Exposure and Outcome Analysis in Children Admitted to the Pediatric Emergency Department

BACKGROUND Pharmaceuticals involved in childhood poisoning vary, and treatment of poison exposure can be a challenge for primary physicians when children are unconscious or histories are lacking. Knowledge of the clinical manifestations and prognosis of poisoning will help primary physicians perform appropriate clinical assessments. In this study, we aim to report on patient characteristics, outcomes, and clinical features of pediatric poisoning in the emergency department. METHODS We retrospectively evaluated the medical records of 87 children younger than 18 years of age and presented to the emergency department with pharmaceutical poisoning (2001-2008). The detailed categories of pharmaceutical were reported, and their associations with patient outcomes were analyzed. Furthermore, children were divided into two groups, based on the reasons for poison exposure (accidental or intentional poisoning). Clinical features and outcomes between accidental or intentional poisoning were analyzed, and the cut-off age for high risk of intentional poisoning was also calculated. RESULTS Age groups of adolescents (48.3%) and preschool age (32.2%) children were the major representation. Neurologic system agents (48.3%) and analgesics (18.4%) were the most common causes of poisoning. Among the two major agents above, anxiolytic/hypnotic drugs (lorazepam) and acetaminophen were the most frequent causes. Of all children, 70.1% had duration of major symptoms for ≤1 day, and intentional poisoning caused significantly longer duration of hospital stay than accidental poisoning did (p=0.008). Moreover, female gender (p<0.001), older age (p<0.001), and analgesics (p=0.008) were more predominantly associated with intentional poisoning in children, and the cut-off age for high risk of intentional poisoning was over 10.5 years. CONCLUSION Neurologic system agents and analgesics were responsible for the majority of cases. Intentional poisoning caused longer hospital length of stay than accidental poisoning, and the factors associated with intentional poisoning were older age, female, and neurologic system agents.

Predictive factors of the duration of a first-attack acute urticaria in children.

PURPOSES This studys aim was to determine the predictive factors of the duration of first-attack acute urticaria in children. BASIC PROCEDURES The sample included 1075 children admitted to the emergency department with first-attack acute urticaria. Variables comprising the clinical features and past histories of children with duration of disease of 3 days or less, 4 to 7 days, 8 to 14 days, and 15 days or more were compared to determine the predictors of duration of acute urticaria. MAIN FINDINGS Age, various etiologies, clinical presentations, coexistent pyrexia or angioedema, and personal histories of allergic diseases were significant factors (all P < .05). Among allergic diseases, atopic dermatitis was the most significant predictor of duration of acute urticaria, and those with multiple allergic diseases had longer durations of urticaria (both P < .05). Oral plus injection forms of antihistamine or steroid were related to shorter duration of disease (P < .05). PRINCIPAL CONCLUSIONS Etiologies and personal allergy history may be the most important predictors of the duration of a first attack of acute urticaria.

Hematuria as the only symptom at initial presentation of hypovolemic shock caused by ruptured renal arteriovenous malformations

Gross hematuria is a very common complaint in emergency departments and outpatient clinics. Globally, the incidence of hematuria is 4 per 1000 patients per year. Infection, urolithiasis, and neoplasm are the most common etiologies. However, hematuria rarely causes hypovolemic shock or an emergent, life-threatening condition at the initial presentation. In this report, we describe the case of a 64-year-old man who suffered a life-threatening gross hematuria in a very short time due to ruptured renal arteriovenous malformations (AVMs).