Pediatric emergency room presentation of congenital heart disease.
OBJECTIVE
Only a few studies have specifically investigated the reasons for emergency room (ER) visits in patients with congenital heart disease (CHD). The aim of this study was to identify the major reasons for ER presentation among patients with CHD that were acutely and seriously ill at a tertiary medical center in Korea.


METHODS
All 368 admissions of patients with CHD via the ER from 2003 to 2008 were enrolled. We conducted a retrospective study with review of the medical records.


RESULTS
Eighty two patients were newly diagnosed as having CHD. Their major presentations were: symptoms of heart failure (41.5%), murmur (31.7%), and cyanosis (18.3%). There were 286 visits that were cases with known CHD. Their major presentations were respiratory tract infection (24.1%, 2.7+/-4.1 years of age), dysrhythmia (16.4%, 16.7+/-9.5 years), symptoms of heart failure (14.3%, 7.6+/-9.4 years), aggravated cyanosis (5.6%, 0.8+/-1.4 years), protein-losing enteropathy (4.9%), hemoptysis (4.5%), drug side effects (4.1%), and infective endocarditis (3.0%). There were significant correlations between the age distributions and major modes of presentation. Surgical treatments were required within 1 month in 38%, and 2.7% of all patients died during hospitalization. The patient group with respiratory infections and CHD showed the highest mortality (5.8%). Atrial flutter was the most frequent arrhythmia (70.2%) and 70% of these patients were post-Fontan surgery condition. The causes of heart failure in the patients with previous surgical repair were: pulmonary hypertension, myocardial dysfunction, valve regurgitation, and uncorrected lesions.


CONCLUSIONS
Improved understanding of the common problems in the ER can help prepare clinicians to manage patients that present with CHD.
Lee
Yun Sik
YS
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Baek
Jae Suk
JS
Kwon
Bo Sang
BS
Kim
Gi Beom
GB
Bae
Eun Jung
EJ
Noh
Chung Il
CI
Choi
Jung Yun
JY
Yun
Yong Soo
YS