Assessment of pediatric emergency department visits among immigrant patients aged below eighteen between 2020-2022

Objective: The individuals who are exposed to the destructive effects of war and migration suffer from many physical and psychological damages, and undoubtedly, children who are the most vulnerable and dependent on an adult are affected the most. Children are exposed to health problems due to reasons such as financial difficulties, housing and nutrition problems, lack of protective health services, and limited medical care facilities. Although there are studies on the risky health conditions of immigrant children and their needs in the literature, there are limited studies examining emergency department visits. The aim of this study is to determine the demographic and clinical characteristics, examination and treatment analyses of Syrian patients who apply to the pediatric emergency department, to reveal the current health status of immigrant children, and to contribute to the efficient planning of health services in emergency departments. Materials and Methods: The study is a descriptive and retrospective research that includes Syrian patients under the age of 18 who applied to the Pediatric Emergency Department of Ankara Bilkent City Hospital between 01.01.2020 and 31.12.2021. A total of 238,813 records of admissions to the Pediatric Emergency Department were examined using the hospital information system, and 3505 emergency admissions of 2602 Syrian patients were identified. The study collected information such as the patients' age, gender, date and time of admission, mode of arrival (walk-in or ambulance), communication problem, chief complaint and affected system, duration of the complaint, whether there were any re-admissions for the same complaint within 48 hours after the first admission, presence of chronic illness, triage level, use of hospital resources, interventions and treatments applied in the emergency department, treatment location (outpatient, pediatric emergency observation room, or inpatient after initial evaluation), length of follow-up in the emergency department, and treatment outcome (discharge, referral, hospitalization, or death). Results: Of the patients who applied to our Pediatric Emergency Department, 1.6% were Syrian children. Applications were more frequent on weekdays (76.8%) 13 and during working hours (49.9%), and the rate of repeated applications was 18.6%. The male gender ratio was 57.4%, and the average age of the patients was 52.6 ± 61.1 months. Toddlers, aged between 12-71 months, were the majority (37.6%). According to the triage evaluation, most patients were at level 3 of the Emergency Severity Index (33.5%). It was found that the severity of the disease was higher in the newborn age group, first-time applicants, those with communication problems, those who applied at night, and those with acute onset of complaints (p<0.01). The most common complaints of the patients were cough and respiratory distress, and the most affected system was the respiratory system, followed by the gastrointestinal system. Oxygen therapy and nebulization were the most commonly used emergency interventions. Hospital resources such as laboratory tests, imaging methods, and consultation were used at a rate of about 85%. Less than an hour of follow-up was conducted for 44.7% of the patients in the Pediatric Emergency Service, and 70% of them were discharged from the emergency department. Conclusion: It has been shown that the severity of Syrian patients' triage levels is increased when they belong to special age groups such as neonates, experience communication problems due to foreign language, have recently started symptoms, or arrive by ambulance. Differences may exist in the epidemiological characteristics of patients who apply to emergency departments of hospitals in different regions. Therefore, each center providing service should know its own past information, needs, and conditions, and plan for the future accordingly. Defining the health services according to the patient profile and determining the characteristic features of emergency patients will increase the quality of service.