Linying Guo

Background: Acute pharmaceutical exposure in children can lead to severe health outcomes and contribute to the inefficient use of medical resources. Objective: This study aimed to investigate the clinical characteristics and outcomes of children with acute pharmaceutical exposure to guide the development of preventive strategies and educational initiatives. Methods: We analyzed real-world data from electronic medical records of children admitted to the emergency department of a pediatric hospital for acute pharmaceutical exposure between January 2019 and December 2023. Clinical data, including laboratory test results, interventions, and outcomes, were collected. We compared different exposure events and conducted logistic regression analysis to identify risk factors for hospitalization. Results: A total of 653 children were included in the study. The most common drugs involved in exposure were vitamins (149/653, 22.8%), nonsteroidal anti-inflammatory drugs (92/653, 14.1%), and psychiatric drugs (74/653, 11.3%). In total, 74.3% (469/631) of patients with complete clinical manifestation data showed no symptoms after exposure, and 68.1% (445/653) of patients did not require specific therapy. Toxicology screening was performed for 11% (72/653) of the children, and 69.4% (50/72) of these tests were positive. Independent risk factors for hospitalization included multisystem involvement (odds ratio [OR] 4.575, 95% CI 1.709-12.251, P=.002), psychiatric drugs (OR 6.280, 95% CI 2.189-18.020, P=.001), and intentional poisoning (OR 12.892, 95% CI 2.222-74.796, P=.004). Conclusions: Children with acute pharmaceutical exposure exhibit diverse clinical characteristics and outcomes, with most requiring no specific treatment. However, immediate toxicology screening and clinical intervention are essential for those exhibiting rapidly developing or multisystem symptoms, as well as those with intentional exposure or exposure to known highly toxic substances. Future pediatric health care policies should emphasize safe storage practices and public education on the prevention of pharmaceutical exposure.

Objective: This study aims to systematically analyze the epidemiological characteristics, clinical interventions and outcomes of children with acute non-pharmaceutical toxic exposures.Methods: This retrospective study included all children with acute non-pharmaceutical toxic exposure admitted to the emergency department of the Capital Institute of Pediatrics between January 1, 2019, and December 31, 2023. Eligible patients were triaged into red, yellow, and green groups according to their severity condition. Clinical information including demographics, exposure details, clinical manifestation, laboratory results, treatments, and outcomes were extracted from electronic medical records. Univariate and multivariate logistic regression analyses were conducted to identify risk factors associated with hospitalization.Results: Overall, a total of 718 patients with acute non-pharmaceutical toxic exposures was included in this study, infants and toddlers accounting for 57.9%. The male-to-female ratio was 1.16:1. The majority exposure events occurred at home (89.3%) and in urban settings (78.4%). Accidental poisoning was the predominant cause, accounting for 94.7%, and the primary route of exposure was oral (93.6%). Mercury was the most common exposed substance, representing 18.8% of cases, particularly among preschool-aged children (31.7%). Patients triaged to red zone had a higher proportion of clinical manifestation and required more aggressive treatments. Although most patients discharged without treatment (78.4%), 19.1% need emergency observation, and 2.5% required hospitalization. Logistic regression analysis showed that corrosive household products exposure (OR = 42.747, 95% CI[5.041–362.520]), skin and mucosal damage (OR = 37.052, 95% CI[5.339–257.153]), pesticides exposure (OR = 33.322, 95% CI[3.863–287.423]), heavy metals exposure (OR = 31.636, 95% CI[1.471–680.210]), neurological manifestation (OR = 22.656, 95% CI[4.766–107.711]), positive toxicology results (OR = 15.105, 95% CI[6.584–34.656]), industrial products exposure (OR = 10.294, 95% CI[1.144–92.641]), and intentional poisoning (OR = 3.060, 95% CI[1.733–5.405]) associated with hospitalization.Conclusion: Pediatric patients exposed to some specific toxicants like industrial products and corrosive household products might associated with a higher risk of severe clinical outcomes. Advocating for enhanced safety regulations or educations and public health initiatives to mitigate the incidence of such exposures is still important for protecting children's health.

Background: The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China’s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective: This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods: This retrospective analysis involved patients who were admitted to the emergency department of Children’s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results: In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features “wait.green” and “department” had the most significant influence on waiting times. Conclusions: This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China.

Objective: This study aimed to investigate the impact of COVID-19 vaccination on the clinical characteristicsand care needs of infected children during a high-intensity pandemic and to measure the potential effects of vaccination on children’s health status and healthcare utilization. Methods: A sample of 903 children who had recently been infected with the novel coronavirus and came to our hospital’s emergency department from January 11 to January 30, 2023, was used as the research object in this retrospective study. The questionnaire on unknown coronavirus infection was filled out anonymously, and SPSS20.0 software was used for statistical data analysis. Results: The baseline conditions of 903 subjects were studied, including 505 males, accounting for 55.92%, and 398 females, accounting for 44.08%. The age of infection was mainly concentrated in preschool children (26.02%) and school-age children (38.76%). Regarding vaccination, 561 cases were vaccinated, accounting for 62.13%. Among them, 37 children received one dose of vaccine, accounting for 4.1%, 463 children received two doses, accounting for 51.27%, and 61 children received three doses, accounting for 6.76%. For previous allergic diseases, 180 children had a history of allergic diseases, accounting for 19.93%. Regarding sources of infection, the most common source was someone at home, accounting for 82.61%. Vaccination can effectively reduce the fever of children infected with the new coronavirus, the number of outpatient and emergency doctor visits, and the risk of hospitalization. In addition, regarding treatment, children in the vaccinated group were more likely to be treated at home, and the types of drugs used also differed from those in the non-vaccinated group. However, the vaccination group has a relatively high incidence of symptoms such as sore throat, cough, abnormal sense of smell and taste, muscle soreness, and headache. However, these are mild clinical symptoms and do not affect children’s physical health and development. Parental care needs for children infected with COVID-19 are disparate, and parents of vaccinated children have lower proportions of needs for child care. Conclusion: Vaccination positively impacts the clinical outcomes of children infected with COVID-19 and their parents’ well-being.

BACKGROUND The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China’s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. OBJECTIVE This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. METHODS This retrospective analysis involved patients who were admitted to the emergency department of Children’s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. RESULTS In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features “wait.green” and “department” had the most significant influence on waiting times. CONCLUSIONS This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China.

We assessed the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and community-acquired pneumonia (CAP) among Chinese children. This observational study examined children aged 3 days to 14 years (n = 1582) from the Capital Institute of Pediatrics in 2009 to 2011. There were 797 children in the CAP group and 785 controls. The CAP group was divided into 2 groups: a pneumonia group and pneumonia-induced sepsis group. The serum 25(OH)D level was estimated using micro whole blood chemiluminescence. The average serum 25(OH)D level in all samples was 25.32 ± 14.07 ng/mL, with the CAP group showing a lower value than the control group (P < .001). There were also significant differences between the pneumonia group and pneumonia-induced sepsis group (P < .001). In the pneumonia-induced sepsis group, significant differences in serum 25(OH)D levels were observed in children who received mechanical ventilation or presenting with multiple organ dysfunction (P < .01). All serum 25(OH)D levels in the pneumonia group and pneumonia-induced sepsis group were below normal levels, particularly in the sepsis group. A lower serum 25(OH)D level was associated with more serious symptoms in CAP children. Children with low serum 25(OH)D levels may be at higher risk of receiving mechanical ventilation and presenting with multiple organ dysfunction. These findings suggest that vitamin D supplements are beneficial for the treatment and prevention of CAP.