RESUMO
OBJECTIVE: To characterize pediatric Emergency Medicine Service (EMS) transports to the Emergency Department (ED) using a national claims database. METHODS: We included children, 18â¯years and younger, transported by EMS to an ED, from 2007 to 2016 in the OptumLabs Data Warehouse. ICD-9 and ICD-10 diagnosis codes were used to categorize disease system involvement. Interventions performed were extracted using procedure codes. ED visit severity was measured by the Minnesota Algorithm. RESULTS: Over a 10-year period, 239,243 children were transported. Trauma was the most frequent diagnosis category for transport for children ≥5â¯years of age, 35.1% (age 6-13) and 32.7% (age 14-18). The most common diagnosis category in children <6â¯years of age was neurologic (29.3%), followed by respiratory (23.1%). Over 10â¯years, transports for mental disorders represented 15.3% in children age 14 to 18, and had the greatest absolute increase (rate differenceâ¯+â¯10.4 per 10,000) across all diagnoses categories. Neurologic transports also significantly increased in children age 14 to 18 (rate differenceâ¯+â¯6.9 per 10,000). Trauma rates decreased across all age groups and had its greatest reduction among children age 14 to 18 (rate differenceâ¯-â¯6.8 per 10,000). Across all age groups, an intervention was performed in 15.6%. Most children (83.3%) were deemed to have ED care needed type of visit, and 15.8% of the transports resulted in a hospital admission. CONCLUSION: Trauma is the most frequent diagnosis for transport in children older than 5â¯years of age. Mental health and neurologic transports have markedly increased, while trauma transports have decreased. Most children arriving by ambulance were classified as requiring ED level of care. These changes might have significant implication for EMS personnel and policy makers.
Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Adolescente , Distribuição por Idade , Ambulâncias/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/terapia , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/terapia , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Distribuição por Sexo , Estados Unidos/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapiaRESUMO
The Ministry of Health of Panama (MINSA) received several reports of ill persons who had clinical presentations of acute renal insufficiency or failure during September and October 2006. On 01 October 2006, the MINSA formally asked the Pan-American Health Organization (PAHO) and the US Centers for Disease Control and Prevention (CDC) to assist with the investigation. Additional agencies involved in the response included the US Food and Drug Administration (FDA), the Gorgas Institute for Health Studies (GIHS), and the Social Security Health System (SSHS) of Panama. Through a joint effort, the MINSA, CDC, FDA, GIHS, SSHS, and PAHO were able to characterize the illness, identify the etiological agent, identify the population-at-risk, and launch an unprecedented media and social mobilization effort to prevent additional cases.International outbreak responses may require familiarity with basic emergency management principles beyond technical or scientific considerations. The management, logistical capabilities, team interaction, and efficiency of outbreak investigations can be enhanced substantially by having staff already familiar with common operational frameworks for incident responses. This report describes the inter-agency coordination and organizational structure implemented during an international response to identify the cause of an outbreak of acute renal failure in Panama.
Assuntos
Injúria Renal Aguda/etiologia , Surtos de Doenças , Cooperação Internacional , Administração em Saúde Pública , Injúria Renal Aguda/epidemiologia , Centers for Disease Control and Prevention, U.S. , Métodos Epidemiológicos , Humanos , Estudos de Casos Organizacionais , Organização Pan-Americana da Saúde , Panamá/epidemiologia , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVE: To characterize postnatal maturation of the biphasic ventilatory response to hypoxia in order to determine whether it persists beyond the first weeks of life in preterm infants, and the contributions of respiratory frequency and tidal volume to this response. METHODS: Stable preterm infants were studied at two postnatal ages, 2 to 3 weeks (n = 12) and 4 to 8 weeks (n = 12), before hospital discharge at 35 weeks (range, 33 to 38 weeks) of postconceptional age. Infants were exposed to 5 minutes of 15% (or 13%) inspired oxygen; ventilation, oxygen saturation, end-tidal partial pressure of carbon dioxide, and heart rate were simultaneously recorded. RESULTS: Minute ventilation exhibited a characteristic biphasic response to hypoxia at both postnatal ages, regardless of the development of periodic breathing. At both ages there was a transient increase in tidal volume, which peaked at 1 minute, accompanied by a sustained decrease in respiratory frequency as a result of significant prolongation of expiratory time. CONCLUSION: The characteristic biphasic ventilatory response to hypoxia persists into the second month of postnatal life in preterm infants. We speculate that this finding is consistent with the prolonged vulnerability of such infants to neonatal apnea.