The Utility of a Travel Screen at Triage in Pediatric Emergency Medicine.
Adolescent
Child
Child, Preschool
Disease Outbreaks
/ prevention & control
Emergency Service, Hospital
Female
Hemorrhagic Fever, Ebola
/ diagnosis
Humans
Infant
Infant, Newborn
Male
Mass Screening
/ methods
Pediatric Emergency Medicine
Retrospective Studies
Travel
Triage
United States
/ epidemiology
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
pubmed:
10
5
2020
medline:
23
3
2021
entrez:
9
5
2020
Statut:
ppublish
Résumé
The travel screen was implemented by emergency departments (EDs) across the country in 2014 to detect patients exposed to Ebola early and prevent local outbreaks. It remains part of the triage protocol in many EDs to detect communicable disease from abroad and has become a defacto screen for other travel-related illness. Its utility has not been studied in the pediatric ED. This was a retrospective review of electronic medical records across 3 EDs from January 1, 2016, to December 31, 2016. The screening question reads, "Has the child or a close contact of the child traveled outside the United States in the past 21 days?" A follow-up question requesting travel details is included for positive screens. We compared length of stay, return-visit rates, and differences in disposition between patients with positive and negative travel screens using generalized linear regression. Matched regression estimates, 95% confidence intervals, and P values were reported. The study population included 152,945 patients with a total of 322,229 encounters in 2016, of which 232,787 encounters had a travel screen documented during triage. There were 2258 patient encounters that had positive travel screens. Only 201 (8.9%) of these encounters had further description of the travel in the comments box. The odds of hospital admission for patients with positive travel screens were 1.76 (95% confidence interval, 1.54-2.01; P < 0.001) times the odds of hospital admission for patients screened negative. The significance of this finding was largely driven by general hospital admission. Other metrics did not differ significantly between the groups. Although a positive travel screen was mildly predictive of inpatient admission, information is not available to providers about travel-related risk. Recent literature suggests integrating a travel history with presenting symptoms and region of travel and could produce a more specific travel screen. A revised travel screen should be implemented and studied in the pediatric ED.
Sections du résumé
BACKGROUND
BACKGROUND
The travel screen was implemented by emergency departments (EDs) across the country in 2014 to detect patients exposed to Ebola early and prevent local outbreaks. It remains part of the triage protocol in many EDs to detect communicable disease from abroad and has become a defacto screen for other travel-related illness. Its utility has not been studied in the pediatric ED.
METHODS
METHODS
This was a retrospective review of electronic medical records across 3 EDs from January 1, 2016, to December 31, 2016. The screening question reads, "Has the child or a close contact of the child traveled outside the United States in the past 21 days?" A follow-up question requesting travel details is included for positive screens. We compared length of stay, return-visit rates, and differences in disposition between patients with positive and negative travel screens using generalized linear regression. Matched regression estimates, 95% confidence intervals, and P values were reported.
RESULTS
RESULTS
The study population included 152,945 patients with a total of 322,229 encounters in 2016, of which 232,787 encounters had a travel screen documented during triage. There were 2258 patient encounters that had positive travel screens. Only 201 (8.9%) of these encounters had further description of the travel in the comments box. The odds of hospital admission for patients with positive travel screens were 1.76 (95% confidence interval, 1.54-2.01; P < 0.001) times the odds of hospital admission for patients screened negative. The significance of this finding was largely driven by general hospital admission. Other metrics did not differ significantly between the groups.
CONCLUSIONS
CONCLUSIONS
Although a positive travel screen was mildly predictive of inpatient admission, information is not available to providers about travel-related risk. Recent literature suggests integrating a travel history with presenting symptoms and region of travel and could produce a more specific travel screen. A revised travel screen should be implemented and studied in the pediatric ED.
Identifiants
pubmed: 32384394
doi: 10.1097/PEC.0000000000002116
pii: 00006565-202008000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
384-388Références
Centers for Disease Control and Prevention. Identify, isolate, inform: emergency department evaluation and management for patients under investigation (PUIs) for Ebola virus disease (EVD). Available at: http://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/emergency-departments. Accessed February 28, 2020.
World Tourism Organization. International Tourism Highlights, 2019 Edition. Available at: https://www.e-unwto.org/doi/pdf/10.18111/9789284421152. Accessed February 28, 2020.
Wu HM. Evaluation of the sick returned traveler. Semin Diagn Pathol. 2019;36:197–202.
Yaffee AQ, Isakov A, Wu HM. How can emergency departments better prepare for emerging infectious disease threats? A returned traveler with fever walks into triage. J Emerg Med. 2019;56:568–570.
American Academy of Pediatrics. Infectious disease outbreaks, epidemics, and bioterrorism/environmental health emergencies. Available at: https://www.aap.org/en-us/Documents/proresources_id_outbreaks.pdf. Accessed February 28, 2020. Chemical-.
Chung S, Baum C, Nyquist AC; Disaster Preparedness Advisory Council, Council on Environmental Health, Committee on Infectious Diseases. Biological terrorism and its impact on children. Pediatrics. 2020;145:e20193750.
Stephens DS, Ribner BS, Gartland BD, et al. Ebola virus disease: experience and decision making for the first patients outside of Africa. PLoS Med. 2015;12:e1001857.
Kenealy M. Second nurse with Ebola arrives at Emory. ABCNews. 2014. Available at: https://abcnews.go.com/Health/nurse-ebola-arrives-emory/story?id=26212955.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, N.J: Lawrence Erlbaum; 1988.
Burkholder TW, Dziadkowiec O, Bookman K, et al. Adherence to universal travel screening in the emergency department during epidemic Ebola virus disease. J Emerg Med. 2019;56:7–14.
Leuthard D, Berger C, Staubli G, et al. Management of children with travel-related illness evaluated in a pediatric emergency room. Pediatr Infect Dis J. 2015;34:1279–1282.
Kesten JM, Audrey S, Holding M, et al. Qualitative study of Ebola screening at ports of entry to the UK. BMJ Glob Health. 2018;3:e000788.
Thwaites GE, Day NP. Approach to fever in the returning traveler. N Engl J Med. 2017;376:548–560.