JPED Journal

Keywords: Children; King Fahad Hospital; Emergency department; Cough; Respiratory distress

Abbreviations:

KFH: King Fahad Hospital

CRS: Clinical Respiratory Score

ACS: Acute chest syndrome

SCA: Sickle cell anemia

SPSS: Statistical package for social sciences

WHO: World Health Organization

BA: Bronchial asthma

BPN: Bronchopneumonia

Pts: patients

Introduction

Respiratory diseases remain significant causes of emergency in children, and bronchial asthma, bronchiolitis, and pneumonia are the most common types [1]. The profiles of respiratory illnesses may be influenced by different factors, including differences in climate and risk factors across, worldwide environmental problem [2]. Epidemiological studies have shown different prevalence of respiratory diseases between countries. As mentioned by [3] in his article, the prevalence of respiratory diseases of hospital admission among children are 25% in USA, UK, and 24.7% in Nigeria. Respiratory distress is the main cause to present in Emergency department in Egypt 24.4%, and appropriate hospital, emergency services improve the outcomes, [4]. Published study from Pakistan revealed the respiratory diseases were less common in emergency [5], while in Mozambique the respiratory diseases in children are 29.3% [6]. Bronchiolitis is common in children less than one year in United Kingdom, [7], foreign body inhalation is common in children < 7 year in South Korea [8], while pneumonia was the commonest cause 63% in India [9]. Recurrent reevaluation of the patient after admission in emergency department is important to improve the outcomes [10]. Acute respiratory distress in infants aged 0 to 90 days associated with positive COVID is mild and self-limiting in majority of the cases [11]. Ideal clinical evaluation, identification of etiology and risk factors and proper management can significantly improve the outcome of this illness [12]. The common symptoms and signs of respiratory distress presenting to the emergency department are cough, fever, breathing difficulty, tachypnea, and wheezing. In severe cases, irregular breathing has been documented. The detailed history, clinical examination, imaging, and laboratory evaluation can help to reach the diagnosis and exact cause of respiratory distress in the child.

Objectives

To determine the prevalence, clinical pattern, outcome, and common causes of respiratory distress among pediatric patients presenting to the emergency department in King Fahad Hospital, Al-Baha, Saudi Arabia. No published studies regarding respiratory diseases in the children of Al Baha region are currently available, and this article could serve as an epidemiological reference for respiratory diseases in children in this area.

Material and Methods

This was a hospital-based retrospective cohort study carried out at King Fahad Hospital, Al Baha, Saudi Arabia. Children older than 1 month and younger than 14 years who presented to the emergency department with respiratory distress were included in the study. Patients younger than 1 month and older than 14 years, patients had respiratory diseases associated with comorbid chronic diseases, and patients who tested positive for COVID-19 were excluded. Patients with mild or no respiratory distress treated and discharged from emergency department were also excluded. The data were analyzed using Microsoft Excel 2020. P value (<0.05) and confidence interval (95% CI) were used as the statistical measurements to evaluate outcomes in this study. Files of included patients from May 2022 to May 2023 were reviewed. This study followed the ethical principles for medical research presented in The Declaration of Helsinki [13]. Pediatrics emergency department protocols and guidelines were applied to evaluate all patients. Symptoms, signs, relevant investigation, length of stay, and treatment were registered and reviewed. Information regarding demographic and clinical details, including age, sex, history of contact, comorbidities, clinical features, and lab investigations, were recorded. As shown in (Table 1), this study used Clinical Respiratory Score (CRS) to divide children with respiratory distress into three categories: Mild (< 3), Moderate (4–7), and Severe (8–12), [14,15]. CRS is used to quickly assess the patients in the emergency department, where a quick diagnosis is essential. The patient’s mental status and appearance are also included in the score. The pediatric emergency unit is fully equipped for resuscitation and treatment, and it is managed by specialized staff including interns, pediatric residents, and pediatric emergency consultants. Records reviewed for patient care, age, sex, place, month of presentation, symptoms, signs, length of stay, and outcome were documented. Accepted cases were recorded every month to correspond to the prevalence by season.

Table 1: The Clinical Respiratory Score (CRS)  in children with respiratory distress presenting to the emergency department; CRS score: Mild (< 3), Moderate (4–7), Severe (8–12).

Results

Files of 210 children with respiratory distress were reviewed in this study. This study revealed that the prevalence of respiratory diseases in children 24%. The mean age of patients with respiratory distress was 3.6 years (SD 2.7), ranging from 1 month to 14 years. There were 114 male patients (54.28%) and 96 female patients (45.72%), with male to female ratio 1/1.8 (P< 0.007). As shown in (Table 2) shows, most patients were admitted during the winter, while the fewest patients were admitted during the summer (P< 0.03). In total, 174 patients (82.86%) were younger than 5 years, 30 (14.28%) were between 5 and 10 years, and 6 patients (2.86%) were older than 10 years. As shown in (Table 3) the most common age group presenting with respiratory distress was less than 2 years old, CI95% [1.55-4.21], (p< 0.002). Hyperactive airway was the most common cause of respiratory distress in 48 patients (22.85%), followed by bronchial asthma in 45 patients (21.41%), bronchopneumonia in 45 patients (21.41%), bronchiolitis in 44 patients (20.95%), pneumonia in 10 patients (4.76%), aspiration pneumonia in 10 patients (4.76%), foreign body aspiration in 3 patients (1.43%), croup in 3 patients (1.43%), and acute chest syndrome in 2 patients (1%) known cases of sickle cell disease (P< 0.009). The most common symptoms and signs documented in admitted patients were tachypnea in 179 patients (87.74%), cough in 163 patients (79.90%), fever in 158 patients (75.24%), and rhinorrhea in 149 patients (70.96%). Low saturation was documented in 103 patients (49%), retractions of intercostal muscles in 95 patients (45.24%), wheezing in 60 patients (28.57%), Abdominal pain was documented in 10 patients (4.76%). cyanosis in 5 patients (2.38%), chest pain in 4 patients (1.90%), irritability in 3 patients (1.43%), and miscellaneous symptoms in 20 patients (9.53%), (P< 0.009). Among all patients, 90% were fully vaccinated while 10% were scheduled to complete their vaccinations. Chest X-rays were taken for all patients. Chest X-rays were normal for 85 patients (40.48%), while 125 patients (59.52%) had abnormal findings. Respiratory acidosis was documented in 25 patients (11.90%), and metabolic acidosis was only recorded in 5 patients (2.38%). Four patients (1.90%) were admitted to pediatric intensive care, and inotropes support was required. The average hospital admission was 4 days (3–5 days), it was 5-7 days in patients less than one year (P<0.02). Patients with an improved condition were discharged and scheduled for regular follow-ups as outpatients. No mortality was documented in our study.

Table 2: Distribution of admitted patients per month.

Table 3: Distribution of pts by diagnosis, gender, and age.