Background: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED) at Lady.

Materials and method: Retrospective files review of ED was done for 1 year period January 2017 to January 2018. Data about the children less than 15 years of age was gathered.

Results: In one year period a total 49 311 patients visited the ED, among the patients “history of fallen” were found more frequent 18,078 (36.66) and the second most main diagnosis was trauma (7873). Majority of the admissions were during 10 AM-12 noon shift.

Conclusion: Young children as well as non-urgent cases were predominant. Day shift was the busiest one.

Keywords: Children, Emergency, Fallen, Trauma

INTRODUCTION

Lady Ridgeway Hospital for Children (LRH) is the largest public free of charge Pediatric Hospital in the World. It serves as the national referral center for pediatric care for Sri Lanka. It also serves as local hospital for the population in and around Colombo city for minor ailments.

This hospital has 1000 beds and it treats children below 14 years of age from all over the country. It has all supportive services required to provide quality patient care.

The total number staff is over 2000 staff members. The medical staff consists of nearly 70 consultants and nearly 300 Medical Officers. They are organized as medical teams headed by permanent senior consultants who have international experience in that particular specialty. Nursing staff consists of nearly 700 Nursing Officers and are organized as teams in line the organization of Doctors.

Emergency department (ED) provide an extraordinary public service mission by providing emergency care for 24 h a day, 365 days per year without discrimination of social and economic status [1]. Provides free comprehensive health care to all children. The Pediatrics ED is an important part of hospital services. In this study we highlighted the pattern of health seeking behavior by pediatrics cases presented to LRH emergency department [2].

MATERIALS AND METHODS

This study based upon the retrospective review of ED files by the medical statics unit of, during the month of October 2019. It is providing secondary to tertiary health care services in the, with a capacity of 24 beds. Triage area. This ED also has a pharmacy, radiology and laboratory facilities. There are surgical facilities with an operation room and ENT, eye and dental procedure rooms are also available for emergency patients. This hospital's ED is open 24 h a day and has a high-volume of turnover with an average annual attendance 49,311.

The pediatric ED typically contained a total of 12 nurses and six resident doctors. ED doctors could call specialist on call of any specialty, to take second opinion for the patients with expected admissions or complications. Only the specialist or consultant  on  call  could  admit  a  patient  as  per  hospital .

policy depending upon the patient's condition. All presenting patients to ED had been sorted out by triage nurse.

The ED files had been attained from the medical record unit and looked for the demographical data of pediatric cases including age groups, i.e., infant (birth-12 months), pre-school child (>12 months to six years) and school going child (>6-12 years) according to standard criteria gender and nationality.

Subjects final diagnosis as documented by ED physician had been collected and categorize.

RESULTS

In one year period a total 49,311 patients visited ED, out of them 18078 came with history of fallen. Another 7873 came with history of trauma.  Males and pre-school children were more frequent, Majority of patients visited in day shift followed by evening, respectively (Table 1 and Figure 1).

In year 2018, 4393 animal bite cases were reported to the emergency department at Lady Ridgeway Hospital. Another major category enter to the accident service were (2466) inhalation of the foreign bodies. There were 1050 road traffic accidents reported.

DISCUSSION

Pediatrics emergency rooms were frequently used for nonemergency problems by parents who find them to be convenient sources of health care for their children. The results of our study showed that nearly one-third of patients (33%) were in the non-urgent category, which were simple cases such as fallen from a bicycle, trauma to head, fallen in the school and animal bites and those could be handled at a primary care clinic. This observation is comparable with other studies [3,4]. 8 males outnumbered the females as were observed by other authors 4 and there are cases more exposed to outdoor environment hazards trauma during playing, as well as fallen from running vehicles. However, the majority of cases were below six years of age (67%). This observation put an extra burden on ED staff, which should have experience in managing infants and pre-school children. The busiest period of the day in our study was “day shift (10 AM to 12 AM) was observed busiest period by other studies and Al Saleh et al. [4] reported 8 PM to 3 AM as the busiest period. It was clearly demonstrated that majority of patients attended the ED for simple problems. This might be because of free medical treatment and/or patients sometimes seek medical advice from different Centre's for the same complaints. This could eventually affect the quality of services, and also lead to an increase in waiting time for patients, as well as a waste of health resources. The recommendations in terms of reducing the number of nonemergency visits to the ED should be strongly stressed [5].

CONCLUSION

Majority of cases were pre-school children and visited in day shift. Less and non-urgent cases were more frequent, which were simple cases such as simple fallen from running bicycle or trauma to head while playing cricket. 

1. Derlet R, Richards J, Kravitz R (2001) Frequent overcrowding in U.S. Emergency Departments: Clinical practice. Acad Emerg Med 8: 151-155.

2. Al Mazrou YY, Khoja T, Rao M (1995) Health services in Saudi Arabia. Proc R Coll Phys Edin 25: 263-266.

3. Williams K (1984) Who uses the accident service? Injury 16: 35-37.

4. Al Saleh QA, Al Saleh QA, Qurtom HA, Lubani MM, Al-Shab TS, et al. (1991) Trends in pediatric casualties in a regional hospital of Kuwait. Ann Saudi Med 11: 171-174.

5. Dorland S (1999) Illustrated medical dictionary. 28^th Edn. USA: W. B. Saunders Company, pp: 31-1385.