The Relationship between Chief Complaint and Hospitalization Rate in Age Categories in Pediatric Emergency Department in Japan

Background: Medical interview information contributes to diagnosis. Differential diagnosis and severity is different according to the age in childhood. However, the relationship between age, severity and admission rate in children with the chief complaint (CC) related respiratory symptom is unclear yet.

Purpose: To clarify the relationship between CC related respiratory symptom and hospitalization rate in each age categories at emergency department (ED) in Japan.

Methods: A retrospective cohort study was performed for patients under age of 18 years who visited ED at two pediatric tertiary hospitals in Japan from August 2014 through September 2016. These patients were classified into 6 age categories: group1 as birth to 28 days; group2 as 29 days to 12 months; group3 as 13 moths to 2 years; group 4 as 3 to 5 years; group 5 as 6 to 11 years; and group 6 as 12 to 18 years. CC, triage category using Canadian Triage Acuity and Scale (CTAS), and rate of admission to wards were evaluated by age group.

Results: A total of 19,748 case were eligible. In all ages, coughing and nasal discharge were the most frequent CC. The next most frequent CC was infant apnea in group 1, wheezing in group 2 to 5, and allergic reactions in group 6.

The frequent CCs in patients who had admitted each group were as below: stridor, wheezing, and infant apnea in group 1; infant apnea, respiratory arrest, and shortness of breath (SOB) in group 2; hemoptysis, SOB, and wheezing in group 3; respiratory arrest, SOB, and wheezing in group 4; SOB, wheezing, and stridor in group 5; and respiratory arrest, foreign body, and wheezing in group 6.

Conclusion: The relationship between CC and admission rate differed according to the age categories. To evaluate patients’ condition, medical interview considering patients’ age must be important.