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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Disease Spectrum and Triage Assessment among Children Presenting to the Paediatric Emergency Department at a Tertiary Care Centre in Telangana, India
Correspondence Address :
Hima Bindu Tirumani,
3-1-353, SBH Colony, Venture-3, L. B. Nagar, Hyderabad-500074, Telangana, India.
E-mail: drhimabindu.t@gmail.com
Introduction: Triage is a sorting process to quickly assess patients upon their arrival in the emergency department which helps to stream them to an appropriate location and adequate treatment. Triage assessment helps in recognising the commonly presenting childhood emergencies to optimise quality of care delivered in the Paediatric Emergency Department. Priority attention can be given to the critically ill or injured patients as how long the patient can safely wait, is predicted by triage.
Aim: To provide data on disease spectrum and triage assessment of children presenting to an exclusive Paediatric Emergency Department.
Materials and Methods: This was a cross-sectional study which was conducted from October 2020 to September 2021 over a period of one year in the Paediatric Emergency Department at Niloufer Hospital, a tertiary care children hospital in Hyderabad, Telangana, India. All children in the age group of one month to twelve years triaged by five-level Canadian triage and acute scale were included in the study. Data was collected from the register maintained at the Emergency Department. Descriptive statistics was used to analyse the data. Micosoft excel sheets were used for recording data.
Results: During the study period, 7986 children were admitted with 5718 (71.6%) males and 2268 (28.4%) females. A total of 4352 (54.5%) patients were less than one year age. Neurological emergencies, acute febrile illnesses, respiratory illnesses were most common reasons for emergency visits. The number of chidren presenting with triage level 1,2,3 were n=4369 (54.71%).
Conclusion: Majority of the patients attending the Emergency Department were less than one year old and acute febrile illnesses and seizures were the most common causes for admissions. Triaging and prioritisation of paediatric emergencies is strongly recommended for early recognition of life threatening illnesses and to improve outcomes. Specially trained nurses, healthcare professionals trained in Basic Life Support (BLS) and Paediatric Advanced Life Support (PALS) will go a long way in reducing morbidity and mortality.
Early recognition, Life threatening, Neurological, Prioritisation, Seizures, Severity
Triage is a sorting process to quickly assess patients upon their arrival in the Emergency Department (ED) which helps to stream them to an appropriate location and adequate treatment. Triage assessment helps in recognising the commonly presenting childhood emergencies to optimise quality of care delivered in the Paediatric emergency department (1),(2),(3). Priority attention can be given to the critically ill or injured patients as how long the patient can safely wait is predicted by triage. As the clinical presentation of emergencies in children are varied compared to adults, emergency room services of children should cater to these differences (4). Majority of the children, who require emergency care are initially evaluated in community hospitals by physicians, nurses and other healthcare providers (5),(6),(7). Availability of baseline data of various emergencies in children presenting to the emergency department and proper triage assessment helps in identifying children requiring urgent medical attention [8-9]. This helps in conserving manpower and finances and improving the outcome of acute severe illnesses in children in resource limited developing countries (10),(11). It improves communication and public relations and supports surveillance.
A previous published study noted the overcrowding of ED was associated with frequency of case discontinuation and mortality (8). Another study from south India suggested identification of serious illness in children is possible with simple clinical signs and symptoms (9). Data on admissions in Paediatric Emergency Departments are sparse in Telangana.
Therefore, the aim of the present study was to determine the disease spectrum and triage patients presenting to the ED, and to study the most common reasons for admission and prioritise patients requiring immediate life saving interventions.
This was a cross-sectional study conducted from October 2020 to September 2021 over a period of one year in the Paediatric Emergency Department in Niloufer hospital, a tertiary care children hospital in Hyderabad, Telangana, India. Ethical clearance was obtained from the Institutional Ethics Committee vide letter no IEC/OMC/2021/M.NO.(01)/Acad-02. The hospital is a 1000-bedded Paediatric teaching and referral centre, which caters to the patients from Telangana and neighbouring states of Andhra Pradesh, Karnataka, Bihar. Round the clock the emergency room is managed by paediatricians, residents, trained nursing and paramedical staff.
The Paediatric Emergency Department uses a five-level Canadian Emergency Department Triage and Acuity Scale (CTAS) (Table/Fig 1) based on disease acuity and physiological status of the patients (12),(13),(14).
Inclusion and Exclusion criteria: All children in the age group of one month to twelve years were included in the study. Children with triage level 1, 2 or 3 were admitted in the emergency department.
Trauma, burns cases which were managed at a concerned speciality hospital and children with triage level 4 or 5 who were sent home to attend outpatient departments or transferred to the inpatient wards after admission and stabilisation were excluded from the study.
Study Procedure
The Canadian ED triage and acuity system prioritises patient care by the severity of illness. The time to see a physician and timely intervention to improve outcome is the primary operational objective of this triage scale. This scale is widely acceptable and meta analyses suggest that this is a good reliable scale for triage assessment [15-17]. The junior resident supported by the postdoctoral senior resident does the initial triage assessment in the hospital. Based on the triage level assigned and the urgency of care, the management priorities are decided as both observational and admission facilities are available. Data including name, age, gender, date and time of admission, chief complaints, initial physiological categorisation as life threatening or non life threatening, primary (ABCDE) assessment, triage classification as level 1-5, were collected from the register maintained at the Emergency Department.
Statistical Analysis
Data was presented as frequencies and percentages. Descriptive statistics was used to analyse the data. Data was collected in Microsoft excel sheets.
During the one year of study period, 7986 children were admitted in the ED. Of the total patients seen, there were 5718 (71.6%) males and 2268 (28.4%) females with a male to female ratio of 2.5:1. Among these children 4352 (54.5%) children were less than one year age, 1238 (15.5%) children were between 1-5 years and 2396 (30%) were between 6-12 years (Table/Fig 2).
Neurological emergencies were n=1861 (23.3%), of total cases, acute febrile illness comprised n=1836 (22.9%), respiratory cases were n=1812 (22.6%), gastrointestinal cases were n=625 (7.82%). Medicolegal emergencies accounted for n=528 (6.61%), renal emergencies were n=460 (5.76%), haematological emergencies were n=450 (5.63%), cardiovascular cases were n=414 (5.18%) of total cases. Among neurological emergencies seizures were n=1112 (59.7%), meningitis cases were n=304 (16.3%) encephalitis cases were n=155 (8.3%). Among seizures cases, n=496 (44.6%) of patients had simple febrile seizures.
Among respiratory emergencies pneumonia n=752 (41.5%) was the commonest of the respiratory illnesses that required an emergency visit. It was followed by bronchiolitis n=551 (30.4%) and acute asthma n=272 (15%). Acute diarrhoeal disease n=355 (56.8%) was the most common diagnosis among gastrointestinal illnesses seen in the Paediatric Emergency Department. Liver disorders n=84 (13.44%) were the other frequent diagnosis (Table/Fig 3). The number of children presenting with triage level 1,2,3 according to Canadian triage and acuity scale accounted for 54.71% and the children presenting with triage level 4,5 accounted for 45.29% (Table/Fig 4).
The patients attending the Paediatric ED were triaged using the Canadian Emergency Department triage and acuity scale (CTAS) [12-14]. Jimenez and his colleagues found the scale to be a valid instrument for predicting rate of hospital admission, duration of stay in hospital and diagnostic utilisation. Several publications have also validated the reliability of the CTAS and its correlation with resource utilisation in ED’s (15),(16),(17).
Among children presenting to the Paediatric ED seizures, septicaemia, pneumonia were the most common causes for admissions. Boys (71.6%) were brought to the emergency department in more numbers compared to the girls (28.4%). Infants accounted for more than half of total admissions (54.5%) to the Paediatric ED in the hospital indicating the need for triage equipment to cater to the needs of these patients.
Children presenting with acute febrile illnesses (22.9%) were the most common admissions to the emergency. Seizures (13.92%) were the second most common presentation to the emergency. In the emergency department of a Government hospital, which is resource limited, management of status epilepticus is particularly challenging. There is a need to develop feasible and relevant guidelines for seizure management based on availability of medications and capacity and facilities for supportive care such as invasive ventilation.
More than half of the patients (54.7%) presented in triage level 1,2,3 indicating the need for early recognition of life threatening abnormalities in oxygenation, ventilation, perfusion, neurological function. Rapid intervention to correct these abnormalities is the key to successful resuscitation and stabilisation of the Paediatric patient (18),(19),(20). There is delayed presentation for care in low and middle income countries which increases the acuity of illness and associated complications. Mortality and morbidity arise from limited and delayed access to emergency care, lack of proper prehospital care and delayed transport (21),(22),(23). As acute illnesses in children can span the spectrum from simple viral infections to life threatening emergencies, there is an increased need for children attending the ED to have a structured approach for initial evaluation to recognise unstable children at the earliest (24),(25),(26),(27)
Pneumonia and diarrhoea remain major killers of young children. Together, these diseases account for 29% of all deaths of children less than five years of age and result in the loss of 2 million young lives each year (28). Use of vaccines against Streptococcus pneumoniae and Haemophilus influenzae type B, the two most common bacterial causes of childhood pneumonia, and against rotavirus, the most common cause of childhood diarrhoea deaths, substantially reduces the disease burden and deaths caused by these infectious agents. Water, sanitation and hygiene interventions, including access to and use of safe drinking-water and sanitation, as well as, promotion of key hygiene practices provide health, economic and social benefits (28).
Due to the Coronavirus Disease 2019 (COVID-19) pandemic, which had significant impact on society and healthcare there were less number of Paediatric ED visits and admissions in the hospitals. This could be because of less utilisation of healthcare services due to fear of hospital environment or decrease in communicable infectious diseases (29). There is an impact of pandemic on nutritional status of children due to change in economic status and lack of healthy lifestyle habits in children (30).
There was compromise in care and serious problem of overcrowding of ED causing delay to patients with acute emergencies as a large segment of patients had less acute complaints preoccupying medical staff time and resources. The data collected from the present study will help medical care to be delivered in a reasonable time frame due to knowledge of type of illnesses and implementation of an ideal triage system.
Limitation(s)
The data presented in the study was during the COVID-19 pandemic, when the patients attending the ED were comparatively less. The data was collected from only one Institution. So, the results cannot be generalised to other facilities.
Majority of the patients attending the ED were less than one year old. Acute febrile illnesses and seizures were the most common causes for admissions. Based on the findings of the present study authors can anticipate the resources needed and utilise space and resources effectively in the hospital. Specially trained nurses, healthcare professionals trained in BLS and PALS will go a long way in reducing morbidity and mortality. Parent awareness in handling febrile episodes by tepid sponging, improved hydration and to seek early healthcare advice, will help in preventing severe illnesses.
DOI: 10.7860/JCDR/2023/60481.17494
Date of Submission: Sep 27, 2022
Date of Peer Review: Nov 30, 2022
Date of Acceptance: Jan 09, 2023
Date of Publishing: Feb 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 01, 2022
• Manual Googling: Jan 06, 2023
• iThenticate Software: Jan 09, 2023 (17%)
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