Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Nov 18, 2020
Date Accepted: Oct 14, 2021
Evaluating the increased burden in Adult Emergency Departments of cardio-respiratory illness visits during flu and bronchiolitis outbreaks in the pediatric population by a retrospective multicentric time series analysis
ABSTRACT
Background:
Cardio-respiratory decompensation visits have a profound effect on adult Emergency Departments. Given the seasonal aspects of such challenging pathology, it would be advantageous to predict their variations.
Objective:
The goal of this study was to evaluate the increased burden in Adult Emergency Departments (ED) of cardio-respiratory decompensation (CRD) during flu and bronchiolitis outbreaks in the pediatric population.
Methods:
An ecological study was conducted, based on the admissions to the adult ED of University Hospitals (UH) of Grenoble and Saint Etienne, from of June 29th, 2015 to March 22nd, 2020. The outbreak periods of bronchiolitis and flu in the pediatric population are defined with a decision-making support tool, PREDAFLU, used in the pediatric ED. A Kruskal-Wallis variance analysis and a Spearman correlation were performed in order to study the relationship between the number of adult ED admissions for the ICD-10 codes related to cardio-respiratory diagnoses and the presence of an epidemic outbreak as defined with PREDAFLU.
Results:
The increase in visits to the adult ED for cardio-respiratory decompensation (CRD) and the bronchiolitis and flu outbreaks had a similar distribution pattern (CHU Saint Etienne: chi-squared = 102.7, df = 3, p-value < 2.2e-16; CHU Grenoble: chi-squared = 126.67, df = 3, p-value < 2.2e-16) and were significantly linked in both hospital settings (CHU Saint Etienne: Spearman rho 0.64; CHU Grenoble: Spearman rho 0.71). The increase of the ED occupancy for these pathologies was also significantly related to the pediatric respiratory infection outbreaks. These two criteria gave an idea of the increased workload in the ED due to the CRDs during the bronchiolitis and flu outbreaks in the pediatric population.
Conclusions:
This study established a seasonal link between bronchiolitis and flu outbreaks in the pediatric population and an increased workload in adult ED for cardio-respiratory pathologies. A forecasting tool for these outbreaks such as PREDAFLU may therefore be used to give early warnings of increase in activity in adult ED for CRD visits. Clinical Trial: This work is part of the project PREPS-0015-00668 PREDAFLU funded by the French ministry of Public Health and Social Affairs. The Advisory Committee on Data Processing regarding research in the Field of Health (Comité Consultatif sur le Traitement de l’Information en matière de recherche dans le domaine de la Santé - CCTIRS N° : 16-660) and the Commission Nationale de l’Informatique et des libertés (CNIL N° : Act19419915) authorised the collection and the processing of data for this project.
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