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Pediatr Emerg Med J. 2018;5(1):19-24

Publication date (electronic) : 2018 June 28

doi : https://doi.org/10.22470/pemj.2018.00192

Yunkoo Kang, Sowon Park, Hong Koh, Seung Kim

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Yonsei University College of Medicine, Severance Children’s Hospital, Seoul, Korea

강윤구, 박소원, 고홍, 김승

연세대학교 의과대학 소아과학교실 세브란스 어린이병원 소아소화기영양과

Corresponding author Seung Kim (ORCID 0000-0003-4373-9828) Department of Pediatrics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2053 Fax: +82-2-393-9118 E-mail: pedks@yuhs.ac

Received 2018 April 9; Revised 2018 June 19; Accepted 2018 June 19.

Trans Abstract

Introduction

Acute gastroenteritis (AGE) is a common disease of childhood, affecting children several times per year. Thus, associated losses of time and costs are high [1-3]. Because the occurrence of this entity is known to be influenced by regional temperature [4-6], this regional temperature-associated difference in incidence of AGE may appear in Korean children with AGE as well, but insufficient research has been performed on it.

A seasonal assessment of the number of children with AGE who visit the emergency department (ED] may help the guardians to expect the entity, and physicians to facilitate the allocation of resources for emergency medicine in appropriate seasons. Studies regarding the association between the occurrence of AGE due to Campylobacter spp. and regional temperature showed conflicting results [7,8]. To our best knowledge, no authors reported the association in the Korean children.

We aimed to investigate the correlation between the occurrence of AGE and regional temperature in children who visited a Korean tertiary hospital ED.

Methods

Results

1. Clinical characteristics

A total of 31,931 children with AGE visited the ED. The clinical characteristics of the children are shown in Table 1. Most data were available over approximately 90%, except poor oral intake, anorexia, and constipation (available in 20%-70%). Vomiting was the most common manifestation, followed by abdominal pain, diarrhea, and fever. The hospitalized children showed more frequent fever, chills, cough and sputum, compared to those discharged.

Table 1.

Clinical characteristics of the children with acute gastroenteritis who visited the emergency department

2. Correlation between the occurrence of AGE and regional temperature

Fig. 1 presents the biannual trends in the numbers of children with AGE who visited the ED and regional temperatures. The monthly mean temperatures between 2006 and 2016 and numbers of the children are presented in Fig. 2. A positive correlation (r = 0.857) was observed between the number of children who visited the ED and the number of those who were hospitalized. However, these numbers of children exhibited negative correlations (for ED visit, r = -0.845; for hospitalization, r = -0.923) with the monthly mean temperature. Hospitalization rate was highest (2.7%) and monthly mean temperature was lowest (-2.4。C) in January.

Fig. 1.

Biannual trends in the numbers of children with acute gastroenteritis who visited the emergency department and regional temperatures in Seoul, Korea between 2006 and 2016.

Fig. 2.

Negative correlations between the monthly mean numbers of the children with AGE and the monthly mean temperatures (for ED visit, r = -0.845; for hospitalization, r = -0.923). Notably, monthly mean numbers of the children with AGE who visited the ED, and of those who were hospitalized were higher in January, November, and December. AGE: acute gastroenteritis, ED: emergency department.

Discussion

Our study found negative correlations between the occurrence of AGE and regional temperature in a Korean tertiary hospital ED. In addition, a positive correlation was observed between the number of children with AGE who visited the ED and the number of those who were hospitalized. This was the first study to investigate the correlation between the monthly mean numbers of children with AGE and regional temperatures in Korea.

In our current study, vomiting (62.0%) was the most common manifestation of AGE, whereas constipation (2.2%) was least common. Other frequent symptoms included diarrhea, abdominal pain, and fever. The hospitalized children showed more frequent manifestations suggestive of respiratory virus infection, including fever, chills, cough, and sputum. To the best of our knowledge, there is no study comparing symptoms of respiratory virus infection with those of AGE, but it is possible that the occurrence of coinfection due to respiratory viruses have increased in winter [10,11]. In addition, having these various symptoms can affect the physicians’decisions on hospitalization. Hence, decision-making on patient disposition in such cases may need laboratory and imaging work-ups.

The study children with AGE tended to visit the ED, and undergo hospitalization in winter, which are associated with cold weather. This finding contrasts with the higher incidence of food poisoning during warmer seasons, implying that AGE is not due to food poisoning. Although the exact causes of AGE were unknown due to the lack of available stool or blood test results, these cases might have been attributable to rotavirus and norovirus, which are known to be prevalent in winter [12-14]. The frequency of AGE in summer also has decreased owing to the population education on food poisoning, such as handwashing.

This study had some limitations of note. The results may not be easily generalizable due to the single center study design. Some study children resided outside Seoul, and thus the observed correlations may not be fully reflective of the real world. Moreover, some factors besides the regional temperature may contribute to the occurrence of AGE. The low availability of some manifestations, such as a poor oral intake, might affect the results. Finally, decisions on hospitalization were made at the discretion of the ED physicians, rather than according to precise criteria.

In conclusion, many children with AGE may visit the ED, and undergo hospitalization during the cold weather. This finding could help the guardians to expect the occurrence of AGE, and physicians to facilitate the allocation of resources for emergency medicine in winter.

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