Management of children with travel-related illness evaluated in a pediatric emergency room

BACKGROUND: Children travelling are potentially exposed to a wide spectrum of illness, which includes mild self-limiting disease, but also severe illness requiring hospitalization. Risk factors for hospitalization need to be analysed to inform prevention- and treatment strategies for travel-related disease, to make travelling for children - from a medical perspective - more secure. METHODS: We performed a cross-sectional analysis on children with travel-related disease presenting at the Emergency Room of University of Zurich Children's Hospital between July 2007 and December 2012. The profile of children being hospitalized was compared to that of children treated as outpatients. RESULTS: 801 children (57.4% male) were included in the study. 83 children (10.4%) were treated as inpatients. Compared to outpatients, inpatients were significantly more likely to be male, to have travelled to Southern Asia, to have a diagnosis of Salmonella typhi or paratyphi(3.6 % vs. 0.1%, p < 0.0001), pyogenic abscess (3.6% vs. 0.1 %, p < 0.0001) or malaria (1.4 % vs. 0.2%, p = 0.0384). Neurologic diagnoses (such as seizure disorder: 3.6% vs. 0.4%, p < 0.0001) were diagnosed more often among inpatients. Furthermore, inpatients presented more often with non-specific findings such as dehydration (8.5% vs. 0.6%, p < 0.0001): No correlation with inpatient care was seen for VFR/immigrant travel. CONCLUSIONS: Children acquire a wide spectrum of travel-related illness. A careful, detailed travel history is important in children presenting in the Emergency Room with symptoms suggesting infectious disease