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Purpose To evaluate the efficiency of the pediatric emergency ward (PEW) through the outcomes of children hospitalized to the ward by the department of pediatric emergency medicine (PEM). Methods A chart review was completed for children (< 15 years) who were hospitalized to the PEW via the pediatric emergency center from March through May 2021. We compared the general characteristics and details regarding the outcomes depending on the departments they were hospitalized to, namely PEM, pediatrics (PED), and others. Results We analyzed a total of 606 hospitalized children: PEM, 91; PED, 456; and others, 59. In the order listed above, their median ages were 2 years (interquartile range, 1-6), 1 year (0-4), and 9 years (7-14) (P < 0.001). The numbers of children with Korean Triage and Acuity Scale of 1-3 were 71 (78.0%), 400 (87.7%), and 33 (55.9%) (P < 0.001). Median length of stay (LOS) in the emergency department (ED) and hospital tended to be shorter in PEM (ED LOS: PEM, 4.3 hours vs. PED and others, 4.0-6.3 hours; hospital LOS: PEM, 19.0 hours vs. PED and others, 58.5-63.8 hours; all Ps < 0.001). The differences in the LOS were prominent between others and PEM (ED LOS, 1.538 [95% confidence interval, 1.353-1.749]; hospital LOS, 3.375 [2.741-4.157]). Transfers to other departments occurred only in PEM (4.4%) and PED (3.9%) whereas intensive care was performed only in others (27.1%). Return visits showed no difference among the 3 departments. Top 5 chief complaints and primary diagnoses of the children hospitalized to PEM were vomiting, fever, abdominal pain, head injury, and poisoning, and gastroenteritis, concussion, syncope, poisoning, and upper respiratory infection, respectively. Conclusion Hospitalization to PEWs for short-term treatment or observation may relieve overcrowding in EDs or in hospitals, with comparable frequency of return visits.

Abstract Background Fever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the bacterial infection and reduce unnecessary treatment, the classic classification system is based on white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center by incorporating recently studied biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited with a fever at a single institution pediatric emergency center. Methods We retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018. Results A total of 317 patients were analyzed, and 61 were diagnosed with SBI, among which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using the cut-off values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, the sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, and 1.291, respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3 and 88.7%, respectively, and when PCT was added, the PPV and NPV were 30.7 and 92%, respectively, both increased. Conclusion PCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever. It is useful as a single biomarker, and when used in conjunction with classic biomarkers, its diagnostic accuracy is further increased.

Abstract Background Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. Results A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P

This study aims to identify age-related suicide-related factors and changes in suicide rate before and after the onset of the COVID-19 pandemic. Methods: From 2018 to 2020, the patients who presented to the ED of a university hospital with a suicide attempt were classified into adolescents (≤18 years), adults (19–65 years), and elderly (>65 years), and the visits were grouped into before and after COVID-19. Results: There were 853 visits before and 388 visits after COVID-19, and the results showed that the number of adolescent and adult suicide patients increased immediately after the pandemic, but the overall trend did not show a significant difference from before the pandemic. In the adolescents, the ratio of male patients increased, interpersonal and school-related motivations decreased, the poisoning and cutting methods of suicide were more common, and hospitalization admissions increased. Among the elderly, the ratio of female patients increased, the number of single patients and patients without previous psychiatric problems increased, the motives for physical illness and death of people around increased, the falling and hanging methods of suicide were more common, and hospitalization admissions and deaths increased. Conclusion: The impact of COVID-19 on suicide rates and suicide-related factors varies by age group. This finding requires different approaches and methods to suicide prevention based on age.

Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.

The empirical studies on the Black-Scholes (B-S) option pricing model have reported that the model tends to exhibit systematic biases with respect to the exercise price, time to expiration, and the stock's volatility. This paper attempts to test the B-S model with a new approach: derive the confidence interval of the model call option value based on the confidence interval of the estimated variance. The test reports that even when the variance's confidence interval is considered, a systematic deviation between the theoretical "range" of the option price values and the observed market price still exist. If the stock variance is constant over time, the interpretation of the results is that the B-S model is wrong. However, if stock variance changes over time, the interpretation of the results is that the implied volatility in options market prices had a tendency to be significantly higher than the estimate that could have been obtained from historical data. [ABSTRACT FROM AUTHOR]

Purpose The authors aimed to investigate the utility of blood culture (BC) for children with simple febrile seizure (SFS) in the emergency department (ED) in the post-10/13-valent pneumococcal conjugate vaccine (PCV) era. Methods This study was performed at the ED of a tertiary care university-affiliated women and children’s hospital, and involved 3,237 previously healthy children aged 6-60 months who visited the ED with SFS from January 2013 through December 2017. The SFS was defined according to the International Classification of Diseases, 11th Revision codes related to seizure. The children were divided into 2 groups according to the vaccination rates of the period of their visit: the 70-PCV (70%, 2013-2014) and 97-PCV (97%, 2015-2017) groups. The primary outcome was the yield, defined as a true positivity of BC. In addition, we collected information on baseline characteristics, ED length of stay, inflammatory biomarkers, and ED outcomes. Results Of the 1,578 children with SFS who underwent BC, 1,357 belonged to the 97-PCV group. The median age of the study population was 22 months (interquartile range, 16.0-30.0), and 935 children (59.3%) were boys. Of the 41 children (2.6%) with positive BC results, 3 had the yield (0.2%): Staphylococcus aureus in 2 children and Streptococcus pneumoniae in the other. All 3 children belonged to the 97-PCV group. There were 38 contaminated BCs (2.4%; 95% confidence interval, 1.6%-3.2%). The 97-PCV group showed a shorter median ED length of stay (166.0 minutes [108.0-279.5] vs. 143.0 [109.5-209.5]; P = 0.010) and a lower rate of hospitalization (39.4% vs. 12.8%; P < 0.001). No differences between the 2 groups were found in the baseline characteristics and biomarkers. Conclusion This study suggests a low utility of BC in previously healthy children with SFS in emergency settings in the post-10/13-valent PCV era.