Reducing Unnecessary Emergency Department Admissions in Children with Respiratory Tract Infection Symptoms: A Controlled Educational Intervention Study From Turkey

İkbal Hümay Arman, Kübra Temel Aslan, Yusuf Arman, Cigdem Apaydin Kaya

Keywords: family practice, signs and symptoms, pediatric emergency medicine, unnecessary, respiratory tract infections

Respiratory tract infections(RTI), the most common cause of emergency applications in children, can mostly be managed in Family Health Centers(FHC). This requires the right attitude towards RTI symptoms(RTIS).

Research questions:
Can education of mothers reduce unnecessary emergency admissions of children with RTIS and improve their knowledge, attitudes and behaviors(KAB) about RTIS(KABaRTIS)?

This study was a controlled educational intervention in mothers of 6 months–6 years old children. Sample size was calculated as at least 58+58 and reached with convenient sampling. The intervention group was given one-on-one, face-to-face training and a brochure prepared by the researchers. RTIS management and alarm findings were emphasized. Likert-type questions about KABaRTIS, fever-related practices; health services received by their children, number and reasons of applications were compared before(B) and after(A) intervention in control(C) and intervention(I) groups. The scale's cronbach-α coefficient was 0,68-0,72.

223 mothers participated in the study, but it was completed with 178 people(C=118,I=60). There was no significant difference between the groups before the intervention. KAB scores of both groups increased after the intervention(C=B:76.9-A:82.2;I=B:76.9-A:83.6;p<0.001), but the difference between the two groups was not significant(p=0.193). In both groups, emergency admissions for RTIS decreased, but the C-group went to the emergency for RTIS less (p=0.014/p=0.492). The median of the number of admissions decreased for both groups(B:1-A:0,p=0,180). However, emergency department applications due to severity of symptom/disease increased in C-group and decreased in I-group.

There may be a few reasons for not seeing the expected difference between intervention and control group after the intervention. The study population went to the emergency departments less than the average of Turkish population. The training was done in one session. Educational content may have increased sensitivity of mothers in I-group. The importance of this study is being the first educational intervention planned in Turkey to reduce unnecessary emergency admissions in children. However, further long-term studies needed.

Points for discussion:
What do you think about the main reasons of these results?

How can the interventional methods be more accesible and successful?

What do you think about extending this intervention to society through social interactions?