title: Emergency department visits in children with hemophilia.
abstract: BACKGROUND
  The pediatric emergency department (ED) management of bleeding and other complications of hemophilia constitutes an increasingly important component of hemophilia therapy. This retrospective study examined the overall ED use by children with hemophilia in a single center, with a particular aim to investigate visits related to injury or bleeding, and those related to blood stream infection in patients with a central venous catheter (CVC).
  
  
  METHODS
  Electronic medical records of patients with hemophilia presenting to Children's Hospital of Michigan ED were reviewed. Different categories of ED visits over a 5-year period (January 2006-December 2010) were examined.
  
  
  RESULTS
  There were 536 ED visits from 84 male patients (median age 4 years, range 0-21) with hemophilia over the 5-year period. The reasons for ED visits were: injury or bleeding (61.2%); suspected CVC-related infection (11.8%); causes unrelated to hemophilia (19.2%); and routine clotting factor infusion (7.8%). Eighteen visits from six patients were secondary to injury or bleeding in a patient not yet diagnosed with hemophilia. An intracranial hemorrhage was detected in five visits. Overall, 5.4% of all visits represented distinct episodes of bloodstream infection.
  
  
  CONCLUSIONS
  The pediatric ED is an indispensable component of the overall hemophilia care, because: (1) patients with potentially lethal problems such as ICH or CVC-related infection may present to the ED for their initial management; (2) previously undiagnosed patients with hemophilia may also present to the ED for their first bleeding episodes, initiating the diagnostic investigations; (3) the ED provides after-hours treatment service for many episodes of injury or bleeding, and also for clotting factor infusion.
authors.affiliation: Division of Hematology/Oncology, Carman Ann Adams Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA. bulentozgonenel@yahoo.com
authors.forename: Bülent
authors.initials: B
authors.lastname: Özgönenel
authors.forename: Ayesha
authors.initials: A
authors.lastname: Zia
authors.forename: Michael U
authors.initials: MU
authors.lastname: Callaghan
authors.forename: Meera
authors.initials: M
authors.lastname: Chitlur
authors.forename: Madhvi
authors.initials: M
authors.lastname: Rajpurkar
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Lusher
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult