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Pediatric Emergency Medicine Journal > Volume 5(1); 2018 > Article
한국 단일기관 응급실을 방문한 소아환자에서 급성위장염 발생과 지역 기온의 상관관계

Abstract

Purpose

Several studies have investigated the association between acute gastroenteritis (AGE) and regional temperatures. We aimed to investigate the correlation between the occurrence of AGE and regional temperature in Korean children.

Methods

We reviewed the clinical characteristics of children aged 18 years or younger with AGE, defined according to the International Statistical Classification of Diseases, 10th Revision codes, who visited a Korean tertiary hospital emergency department (ED) between 2006 and 2016, and compared the children who were discharged from the ED and those who were hospitalized. Data on temperature in Seoul, Korea during the period were obtained from the Korea Meteorological Administration. Subsequently, we assessed correlations between the monthly mean numbers of the children with AGE and monthly mean temperature using Pearson’s correlation analysis.

Results

A total of 31,931 children with AGE visited the ED. Vomiting was the most common manifestation (62.0%). Fever, chills, cough, and sputum were more frequent in the hospitalized children (P < 0.05). Hospitalization rate was highest (2.7%) and monthly mean temperature was lowest (-2.4。C) in January. We observed negative correlations between the monthly mean numbers of the children with AGE and the monthly mean temperature (for ED visit, r = -0.845; for hospitalization, r = -0.923).

Conclusion

Children with AGE tend to 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.

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

1. Study design and setting

This retrospective chart review included children aged 18 years or younger with AGE who visited the Severance Hospital ED in Seoul, Korea, between 2006 and 2016. The ED provided care to approximately 20,000 children in 2016. AGE was defined according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for AGE (A09). We excluded children having similar symptoms attributed to other causes. The study was approved by the Institutional Review Board (IRB No. 4-2018-0036).

2. Data collection

Clinical characteristics, including age, gender, and clinical manifestations (fever, chills, cough, sputum, rhinorrhea, poor oral intake, anorexia, nausea, vomiting, constipation, diarrhea, and abdominal pain), were collected and compared between the children who were discharged from the ED and those who were hospitalized. We investigated the correlations between the occurrence of AGE (monthly mean numbers of the children with AGE who visited the ED, and of those who were hospitalized) and regional temperature (monthly mean temperature in Seoul during the study period) in the ED. Data on the latter variables were obtained from the Korea Meteorological Administration [9] (Appendix 1).

3. Statistical analysis

Clinical characteristics of the discharged and hospitalized children were compared using the chi-square tests. Correlations between the monthly mean numbers of children and regional temperature were analyzed using Pearson’s correlation coefficients (r). All statistical analyses were performed using SPSS software version 23.0 (IBM Co., Armonk, NY). A P < 0.05 was considered statistically significant.

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.

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.

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.

Conflicts of interest

No potential conflicts of interest relevant to this article were reported.

Acknowledgements

No funding source relevant to this article was reported.

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.
pemj-2018-00192f1.tif
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.
pemj-2018-00192f2.tif
Table 1.
Clinical characteristics of the children with acute gastroenteritis who visited the emergency department
Variable Total (N = 31,931) Discharge (N = 31,293) Hospitalization (N = 638) P value
Age, y 3.7 ± 3.5 3.8 ± 3.5 2.4 ± 2.8 < 0.001
Boys 17,630 (55.2) 17,281 (55.2) 349 (54.7) 0.793
Fever 9,425 (29.5) 9,216 (29.5) 209 (32.8) 0.040
Chills 1,097 (3.4) 1,058 (3.4) 39 (6.1) 0.018
Cough 5,257 (16.5) 5,126 (16.4) 131 (20.5) 0.003
Sputum 3,127 (9.8) 3,049 (9.7) 78 (12.2) 0.028
Rhinorrhea 5,263 (16.5) 5,143 (16.4) 120 (18.8) 0.068
Poor oral intake 458 (1.4) 457 (1.5) 1 (0.2) 0.956
Anorexia 984 (3.1) 963 (3.1) 21 (3.3) 0.489
Nausea 8,227 (25.8) 8,092 (25.9) 135 (21.2) 0.016
Vomiting 19,791 (62.0) 19,426 (62.1) 365 (57.2) 0.030
Constipation 508 (1.6) 497 (1.6) 11 (1.7) 0.640
Diarrhea 10,771 (33.7) 10,542 (33.7) 229 (35.9) 0.168
Abdominal pain 12,223 (38.3) 12,012 (38.4) 211 (33.1) 0.016

Values are expressed as mean ± SD or number (%).

References

1. Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ 1992;70:705–14.
pmid pmc
2. GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 2017;17:909–48.
crossref pmid pmc
3. Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003;81:197–204.
pmid pmc
4. Hashizume M, Armstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T, et al. Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups. Int J Epidemiol 2007;36:1030–7.
crossref pmid pdf
5. Onozuka D, Hagihara A. Nationwide variation in the effects of temperature on infectious gastroenteritis incidence in Japan. Sci Rep 2015;5:12932.
crossref pmid pmc pdf
6. Tam CC, Rodrigues LC, O’Brien SJ, Hajat S. Temperature dependence of reported Campylobacter infection in England, 1989-1999. Epidemiol Infect 2006;134:119–25.
crossref pmid pmc
7. Arsenault J, Berke O, Michel P, Ravel A, Gosselin P. Environmental and demographic risk factors for campylobacteriosis: do various geographical scales tell the same story? BMC Infect Dis 2012;12:318.
crossref pmid pmc pdf
8. Kovats RS, Edwards SJ, Charron D, Cowden J, D’Souza RM, Ebi KL, et al. Climate variability and campylobacter infection: an international study. Int J Biometeorol 2005;49:207–14.
crossref pmid
9. Korea Meteorological Administration. Monthly mean temperature in Seoul [Internet]. Seoul, Korea: Korea Meteorological Administration: c2015[cited 2018 Jun 20]. Available from: https://data.kma.go.kr/stcs/grnd/grndTaList.do?pgmNo=70. Korean.

10. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis 2006;43:585–92.
crossref pmid pdf
11. Regamey N, Kaiser L, Roiha HL, Deffernez C, Kuehni CE, Latzin P, et al. Viral etiology of acute respiratory infections with cough in infancy: a community-based birth cohort study. Pediatr Infect Dis J 2008;27:100–5.
pmid
12. Kovats RS, Edwards SJ, Hajat S, Armstrong BG, Ebi KL, Mennen B. The effect of temperature on food poisoning: a time-series analysis of salmonellosis in ten European countries. Epidemiol Infect 2004;132:443–53.
crossref pmid pmc
13. Chen SC, Tan LB, Huang LM, Chen KT. Rotavirus infection and the current status of rotavirus vaccines. J Formos Med Assoc 2012;111:183–93.
crossref pmid
14. Kim JS, Kim HS, Hyun J, Kim HS, Song W. Molecular epidemiology of human norovirus in Korea in 2013. Biomed Res Int 2015;2015:468304.
crossref pmid pmc pdf

Appendices

Appendix 1.

Monthly mean temperature in Seoul during the study period [9]

Mo 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.* Temp No.*
1 -0.2 45 0.4 106 -1.7 155 -2 225 -4.5 185 -7.2 319 -2.8 323 -3.4 361 -0.7 487 -0.9 547 -3.2 353
2 0.1 43 4 89 -1.2 162 2.9 171 1.4 285 1.2 229 -2 245 -1.2 246 1.9 329 1 368 0.2 273
3 5.2 62 6.1 98 7.3 159 6 145 4.3 347 3.6 273 5.1 311 5.1 281 7.9 280 6.3 254 7 268
4 11.6 50 11.4 114 14.1 154 12.7 167 9.5 350 10.7 246 12.3 291 10 264 14 282 13.3 256 14.1 292
5 18.4 35 18.1 101 17.7 206 19.1 150 17.2 298 17.9 197 19.7 385 18.2 224 18.9 346 18.9 360 19.6 287
6 21.8 45 23.2 97 21.5 197 22.4 198 23.4 238 22 252 24.1 310 24.4 230 23.1 284 23.6 162 23.6 185
7 23.1 74 24.2 87 25.1 243 24.3 136 25.8 251 24.6 244 25.4 208 25.5 227 26.1 307 25.8 171 26.2 257
8 27 74 26.5 117 25.3 179 25.7 160 26.5 231 25.8 257 27.1 210 27.7 265 25.2 259 26.3 285 28 283
9 21.1 70 21.5 119 22 150 21.8 178 21.8 245 21.8 236 21 198 21.8 269 22.1 260 22.4 284 23.1 259
10 17.9 100 15.1 155 16.1 166 16 146 14.5 180 14.2 240 15.3 260 15.8 193 15.6 272 15.5 256 16.1 188
11 8.4 136 6.7 271 7.6 165 6.9 130 6.5 254 10.7 291 5.5 516 6.2 314 9 409 8.9 361 6.8 311
12 1.4 160 1.8 350 1.1 212 -1 253 -1.3 430 -0.9 344 -4.1 563 -0.2 454 -2.9 596 1.6 541 1.2 544

Temperatures are expressed as 。C.

* No. refers to the number of the children with acute gastroenteritis who visited the emergency department.

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