ORIGINAL RESEARCH Open Access
Characteristics and outcomes of pediatric
patients presenting at Cambodian referral
hospitals without appointments: an
Mackensie A. Yore
, Matthew C. Strehlow
, Lily D. Yan
, Elizabeth A. Pirrotta
, Joan L. Woods
, Koy Somontha
, Lauren Auerbach
, Rebecca Backer
, Christophe Grundmann
and Swaminatha V. Mahadevan
Background: Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although
many patients seeking emergency or acute care are children, little information is available about the needs and current
treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints,
management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals.
Methods: Children enrolled in the study presented without appointment for treatment at one of two Cambodian
public referral hospitals during a 4-week period in 2012. Researchers used standardized questionnaires and hospital
records to collect demographic and clinical data. Patients were followed up at 48 h and 14 days after initial
presentation. Multivariate logistic regression identified factors associated with hospital admission.
Results: This study included 867 unscheduled visits. Mean patient age was 5.7 years (standard deviation 4.8 years).
Of the 35 different presenting complaints, fever (63%), respiratory problems (25%), and skin complaints (24%) were
most common. The majority of patients were admitted (51%), while 1% were transferred to another facility. Seven
patients (1%) died within 14 days. Follow-up rates were 83% at 48 h and 75% at 14 days. Predictors of admission included
transfer or referral from another health provider, seeking prior care for the presenting problem, low socioeconomic status,
onset of symptoms within 24 h of seeking care, abnormal vital signs or temperature, and chief complaint of abdominal
pain or fever.
Conclusions: While the admission rate in this study was high, mortality was low. More effective identification and
management of children who can be treated and released may free up scarce inpatient resources for children who
Keywords: Chief complaints, Developing countries, Emergency medicine, Health systems, Pediatrics
In low- and middle-income countries (LMICs), an estimated
45% of all deaths and 36% of disability-adjusted life years
(DALYs) are due to diseases and injuries typically addressed
by emergency medical services that are currently lacking in
these regions . Among these countries is Cambodia, a
lower middle-income nation in Southeast Asia which still
suffers residual effects of the Khmer Rouge regime of the
1970s, during which violence, famine, and preventable
disease killed approximately two million people and
completely dismantled the healthcare infrastructure [2, 3].
Developing emergency medicine in LMICs requires
a great deal of specialized training for providers.
Characterizing the potential emergency department
population in LMICs is an important step in creating
relevant training for future emergency clinicians.
Understanding the distribution of chief complaints focuses
provider education on symptoms with the highest burden
* Correspondence: firstname.lastname@example.org
Department of Emergency Medicine, UCSF Fresno Center for Medical
Education and Research, 155 N Fresno St, Fresno, CA 93701, USA
Full list of author information is available at the end of the article
International Journal of
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Yore et al. International Journal of Emergency Medicine (2018) 11:17