The Nature of Pediatric Complaints in the Post-Disaster Setting: Two Natural Disasters and Two Extensive Relief Efforts
Nichole R. Davis, Charles Macias, Elizabeth Camp, Brent D. KazinyAbstract
Objective
Our objective was to review the prospectively collected data on patient demographics, chief complaints, and resource utilization of internally displaced children in congregate settings established after two natural disasters in a large metropolitan area.
Background
Following Hurricane Katrina, providers from Texas Children’s Hospital (TCH) established a Mobile Pediatric Emergency Response Team (MPERT). Similarly, after Hurricane Harvey in 2017, local Emergency Medical Services (EMS) responded and the federal Disaster Medical Assistance Team (DMAT) deployed, establishing a care area in a shelter for those that had been displaced.
Methods
This retrospective case-control study used data collected prospectively at the post-hurricane medical care areas. A database compiling diagnostic codes utilized was created. Providers labeled each diagnostic code as either acute, chronic or undecided. These labels were assessed for interrater reliability using the Fleiss kappa and presentations in the post-hurricane setting were described and compared to controls utilizing a Chi-Square analysis. When unanimous agreement was not obtained, majority consensus was utilized.
Results
The TCH ED totaled 3,587 patients, the MPERT totaled 3,015 and the DMAT totaled 202 patients. Raters, utilizing the diagnostic code database, showed substantial agreement for all options combined (ĸ = 0.69; p-value <0.0001). 22% of patients presented with chronic complaints compared to 13.6% of the controls (Difference 8.4%, p < 0.0001, 95%CI 6.52–10.31).
Conclusions
In the post-hurricane setting, chronic medical complaints are the primary complaints compared to a routine pediatric EC. These data can be utilized to better prepare post-hurricane shelters.