Pediatric emergency department visits and parental assessment of acutely ill children

Acute illnesses, especially infections, cover the majority of children's diseases and the need for hospitalization. Serious infections among children have decreased in recent decades due to, e.g., a comprehensive vaccination program. Still, the number of visits to children's emergency rooms has increased. A large proportion of acutely ill children suffer from viral diseases that could be treated at home. On the other hand, identifying a severely ill child, especially in the early stages of the disease, is challenging, and the symptoms of the disease can progress rapidly. Remote assessment and care have increased in healthcare services for families with children. However, there is little research on how well parents can assess their children's general condition and symptoms. This dissertation examines which diseases and pathogens bring children to the emergency department nowadays and how pediatric patients in need of emergency care can be identified both in the triage and at home.
This dissertation consists of a cohort of patients in the pediatric emergency department during one epidemiological year (paper I and II), parental measurements of their children's vital signs (paper III), and parental assessments of their acutely ill children's symptoms and general well-being in the pediatric emergency department (paper IV).
The most common diagnoses in pediatric patients admitted to the emergency department were bronchiolitis, viral wheezing, and upper respiratory tract infection. Rhinovirus was the most common pathogen in both emergency and intensive care. Respiratory and heart rate are acutely ill children's most important measurable values. The parents' ability to assess and measure these vital signs was poor, especially in young children. Mobile applications did not improve measurement accuracy. The moderate to high parental worry was very sensitive in identifying the child's serious illness. More detailed questions, for example, concerning a child's crying or reaction to a parent, were not sensitive enough to identify a child needing emergency care. Parental worry about their children should always be taken into account when assessing acutely ill children in emergency departments, triage services, or remote assessments.