Do We Know Where They Go? Obtaining Travel History in Pediatric Patients. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Chilukuri, Pranaya H.; Orr, Mary; Blakemore, Shaundra; Hofto, Meghan E.
• Is Part Of: Southern medical journal. Volume 114:Issue 10(2021)
• Page Start: 640
• Page End: 643
• Publication Date: 2021-10
• Subjects: exposure history -- pediatric travel -- simulation -- travel history; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001302
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Increasing international travel has led to increases in pediatric travel-related diseases. A comprehensive travel history is imperative to promptly diagnose and manage infections acquired abroad. Travel histories often are omitted from routine medical histories in adults. Through retrospective medical record review and prospective observation of initial patient encounters, the frequency of travel histories obtained in pediatric patients was evaluated. Supplemental digital content is available in the text. Abstract : Objective: To determine how often travel histories are obtained in pediatric patients. Methods: A retrospective medical record review was performed at a single tertiary care children's hospital for patients aged 2 months to 18 years who were admitted October 2015–December 2017 with International Classification of Diseases, 10th Revision codes for potential travel-related illnesses. Demographic information and travel history documentation were obtained, along with travel-related testing. From May to June 2018, prospective, single-blinded, direct observation of a convenience sample of pediatric residents was performed during the initial patient encounter to determine the frequency and quality of travel histories obtained regardless of documentation. Results: Of 249 charts reviewed, 27 (10.8%) patients had a travel history query documented. Patients with complex chronic conditions were significantly less likely to have a travel history documented (37% vs 67%; P = 0.005). Age, sex, length of stay, race, payer status, and critical care admission did not significantly differ between groups. Those with a travel history documented were more likely to have a documented exposure history (100% vs 52%; P < 0.001) and additional testing performed (56% vs 13%, P < 0.001). During this time, a simulation course with residents featuring travel-related diagnoses led to a significant increase in documented travel histories (5% prior versus 21% after, P = 0.03). A total of 37 patient encounters were observed; travel history was asked for 4 times (4/37, 10.8%). Conclusions: Travel histories are rarely asked for in pediatric patients. Missed diagnoses may not only affect the patient but also have broader public health implications. Simulation is an effective tool to improve history-taking skills, yet more work is still needed.