{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:58:00Z","timestamp":1791568680181,"version":"4.3.4"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Science Research Project of Hebei","award":["20231127"],"award-info":[{"award-number":["20231127"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze the distribution and epidemiological characteristics of critical illnesses in the emergency department of Hebei Children's Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Through retrospective medical record review, patients triaged as level \u2160 or \u2161 (aged 0\u201318 years) who visited the emergency department of the hospital from January 2023 to December 2024 were included. The distribution of diseases, age, gender, season and other indicators were statistically analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,450 critically ill patients with triage levels \u2160 and \u2161 were included. The median (IQR) age of all patients was 4.00 (1.00, 9.00) years, and the male-to-female ratio was 1.2:1. Among each age group, the 1 to &lt;3 years group had a proportion of 27.9%, and the 0 to &lt;1 year group had a proportion of 9.5%, representing the highest and lowest values, respectively. The distribution of critical illnesses in the emergency department of this hospital was led by the nervous system (n\u2009=\u2009548, 37.8%), trauma and accidental injuries (n\u2009=\u2009286, 19.7%), and the respiratory system (n\u2009=\u2009214, 14.8%), which ranked as the top three categories. The top five primary diagnosed diseases were seizure (n\u2009=\u2009352, 24.3%), drug poisoning (n\u2009=\u2009242, 16.7%), severe pneumonia (n\u2009=\u2009137, 9.5%), status epileptics (n\u2009=\u2009137, 9.5%), and arrhythmia (n\u2009=\u2009102, 7.0%). Among them, the proportion of severe pneumonia was the highest in the 0 to &lt;1 year group; the proportion of seizure was the highest in the 1 to &lt;3 years group, 3 to &lt;6 years group and 6 to &lt;12 years group, while the proportion of drug poisoning was the highest in the 12 to &lt;18 years group. The distribution of the top five disease differed significantly across age groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and seasons (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Cardiopulmonary arrest (CPA) is one of the most critical conditions in an emergency department. However, the distribution of diseases causing CPA did not show significant differences by age or season. The top three diseases causing CPA are severe pneumonia, asphyxia, and multiple body region injuries (Road traffic accident)\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The spectrum of critical illnesses varied significantly by age and seasonal distribution in the emergency department of Hebei Children's Hospital. Therefore, age and season-tailored approaches are recommended for managing common critical illnesses, whereas CPA requires a standardized, universally applied emergency response. It is necessary to further strengthen training and optimize resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360675","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:45:25Z","timestamp":1791567925000},"page":"e0360675","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of the spectrum of critical illnesses in the emergency department of Hebei Children's Hospital: A single-center study"],"prefix":"10.1371","volume":"21","author":[{"given":"Xiao","family":"Wang","sequence":"first","affiliation":[{"name":"Hebei Children's Hospital, Hebei Clinical Research Center for Children's Health and Diseases","place":["Shijiazhuang City, Hebei province, China"],"department":["Emergency Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weili","family":"Guo","sequence":"additional","affiliation":[{"name":"Hebei Children's Hospital, Hebei Clinical Research Center for Children's Health and Diseases","place":["Shijiazhuang City, Hebei province, China"],"department":["Emergency Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yishan","family":"Guo","sequence":"additional","affiliation":[{"name":"Hebei North College","place":["Zhangjiakou City, Hebei province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengli","family":"Hao","sequence":"additional","affiliation":[{"name":"Hebei Children's Hospital, Hebei Clinical Research Center for Children's Health and Diseases","place":["Shijiazhuang City, Hebei province, China"],"department":["Emergency Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Hebei Children's Hospital, Hebei Clinical Research Center for Children's Health and Diseases","place":["Shijiazhuang City, Hebei province, China"],"department":["Emergency Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4727-1486","authenticated-orcid":true,"given":"Gailing","family":"Hao","sequence":"additional","affiliation":[{"name":"Hebei Children's Hospital, Hebei Clinical Research Center for Children's Health and Diseases","place":["Shijiazhuang City, Hebei province, China"],"department":["Emergency Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"1","key":"pone.0360675.ref001","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1186\/s12887-025-05956-3","article-title":"Frequency and profile of pediatric mortality in an emergency department: A retrospective cross-sectional study from a low-middle income country","volume":"25","author":"S Bano","year":"2025","journal-title":"BMC Pediatr"},{"issue":"2","key":"pone.0360675.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(24)00450-9","article-title":"Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): A multicentre, international, point prevalence and prospective cohort study","volume":"13","author":"TB Kortz","year":"2025","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pone.0360675.ref003","doi-asserted-by":"crossref","first-page":"102743","DOI":"10.1016\/j.jiph.2025.102743","article-title":"Infection-related mortality in hospitalized children: A multi-center study in China from 2016 to 2021","volume":"18","author":"J Tian","year":"2025","journal-title":"J Infect Public Health"},{"issue":"15","key":"pone.0360675.ref004","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1001\/jama.2026.3100","article-title":"National estimates of pediatric sepsis in US hospitals using clinical data","volume":"335","author":"C Rhee","year":"2026","journal-title":"JAMA"},{"issue":"3","key":"pone.0360675.ref005","first-page":"177","article-title":"Expert consensus on clinical early warning and early decision-making for severe pneumonia in children","volume":"38","author":"China Maternal and Child Health Association Pediatric Allergy Professional Committee, Editorial Board of the Chinese Journal of Practical Pediatrics.","year":"2023","journal-title":"Chinese J Pract Pediat"},{"issue":"1","key":"pone.0360675.ref006","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.50941","article-title":"Emergency department pediatric readiness and short-term and long-term mortality among children receiving emergency care","volume":"6","author":"CD Newgard","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"4","key":"pone.0360675.ref007","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2021.7419","article-title":"Association of emergency department pediatric readiness with mortality to 1 year among injured children treated at trauma centers","volume":"157","author":"CD Newgard","year":"2022","journal-title":"JAMA Surg"},{"key":"pone.0360675.ref008","doi-asserted-by":"crossref","first-page":"101690","DOI":"10.1016\/j.ienj.2025.101690","article-title":"Patterns of pediatric emergency department visits in a tertiary women\u2019s and children\u2019s hospital in China: A 2021 retrospective analysis","volume":"83","author":"J Zhao","year":"2025","journal-title":"Int Emerg Nurs"},{"issue":"9","key":"pone.0360675.ref009","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/S2352-4642(24)00140-8","article-title":"The burden and contemporary epidemiology of sepsis in children","volume":"8","author":"RS Watson","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"issue":"6","key":"pone.0360675.ref010","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000047534","article-title":"Evolution of the pediatric emergency department morbidity spectrum following the relaxation of non-pharmaceutical interventions: A retrospective analysis of 320,000 encounters","volume":"105","author":"C Chen","year":"2026","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"pone.0360675.ref011","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/ped4.12144","article-title":"Disease spectrum analysis of hospitalized children in China: A study of 18 tertiary children\u2019s hospitals","volume":"3","author":"G Feng","year":"2019","journal-title":"Pediatr Investig"},{"issue":"9","key":"pone.0360675.ref012","first-page":"1232","article-title":"Examining pediatric emergency utilization trends before and after the COVID-19 pandemic: An eight-year cohort study from a south Korean tertiary center","volume":"12","author":"HJ Lee","year":"2025","journal-title":"Children (Basel)"},{"issue":"1","key":"pone.0360675.ref013","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1186\/s12887-025-06101-w","article-title":"Human metapneumovirus in children with acute lower respiratory infections: Effects on clinical and disease severity","volume":"25","author":"S Yang","year":"2025","journal-title":"BMC Pediatr"},{"key":"pone.0360675.ref014","author":"Hebei Children\u2019s Hospital"},{"key":"pone.0360675.ref015","author":"Hebei Children\u2019s Hospital"},{"issue":"11","key":"pone.0360675.ref016","first-page":"849","article-title":"Expert consensus on pre-examination and triage of pediatric emergency (Shanghai)","volume":"29","author":"Shanghai pediatric emergency pre-examination and triage expert consensus writing group","year":"2022","journal-title":"Chinese Ped Emerg Med"},{"key":"pone.0360675.ref017","doi-asserted-by":"crossref","first-page":"1725358","DOI":"10.3389\/fcimb.2026.1725358","article-title":"Analysis of pathogenic characteristics of acute respiratory tract infections in children and the influence of environmental factors in Shijiazhuang area","volume":"16","author":"S Liu","year":"2026","journal-title":"Front Cell Infect Microbiol"},{"issue":"2","key":"pone.0360675.ref018","doi-asserted-by":"crossref","first-page":"106547","DOI":"10.1016\/j.jinf.2025.106547","article-title":"Impact of climate change and extreme temperature on the incidence of infectious disease among children and adolescents in China: A nationwide case-crossover study with over 8.7 million cases between 2008 and 2019","volume":"91","author":"L Chen","year":"2025","journal-title":"J Infect"},{"issue":"4","key":"pone.0360675.ref019","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.annemergmed.2023.10.010","article-title":"Social determinants of health and pediatric emergency department outcomes: A systematic review and meta-analysis of observational studies","volume":"83","author":"S Amjad","year":"2024","journal-title":"Ann Emerg Med"},{"issue":"2","key":"pone.0360675.ref020","first-page":"200","article-title":"Influencing factors of restoration of spontaneous circulation in patients with pre-hospital cardiac arrest","volume":"21","author":"Y Zhang","year":"2026","journal-title":"Chinese J Emerg Resuscit Disaster Med"},{"key":"pone.0360675.ref021","doi-asserted-by":"crossref","first-page":"109856","DOI":"10.1016\/j.resuscitation.2023.109856","article-title":"Pediatric in-hospital cardiac arrest: Respiratory failure characteristics and association with outcomes","volume":"188","author":"LN Shepard","year":"2023","journal-title":"Resuscitation"},{"key":"pone.0360675.ref022","volume-title":"Microsoft excel 2021","author":"Microsoft Corp","year":"2021"},{"key":"pone.0360675.ref023","volume-title":"GraphPad Prism version 9.0.0 for Windows","year":"2020"},{"key":"pone.0360675.ref024","volume-title":"IBM SPSS statistics for windows, Version 26.0","author":"IBM Corp","year":"2019"},{"issue":"19","key":"pone.0360675.ref025","first-page":"29","article-title":"Safety risks and influencing factors of interhospital transport of critically ill patients","volume":"14","author":"JL Zhuang","year":"2023","journal-title":"Chinese Health Stand Manag"},{"issue":"2","key":"pone.0360675.ref026","first-page":"87","article-title":"Critically ill children\u2019s hospital in southwest China international transshipment expert consensus","volume":"20","author":"Southwest pediatric Intensive Care Alliance of National Children\u2019s Regional Medical Center, pediatric Intensive Care physicians Branch of Chongqing Medical Doctor Association, Expert consensus group on inter-hospital transport of critically ill children in Southwest China","year":"2025","journal-title":"Chinese J Evid-based Pediat"},{"issue":"10","key":"pone.0360675.ref027","first-page":"86","article-title":"Ariations in anhui province in 2013-2017 hospitalized children change analysis","volume":"23","author":"X Wang","year":"2022","journal-title":"China Med Rec"},{"issue":"2","key":"pone.0360675.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0264184","article-title":"Machine learning-based prediction of critical illness in children visiting the emergency department","volume":"17","author":"S Hwang","year":"2022","journal-title":"PLoS One"},{"key":"pone.0360675.ref029","article-title":"Disease spectrum and triage assessment among children presenting to the paediatric emergency department at a tertiary care centre in Telangana","author":"N Cherukuri","year":"2023","journal-title":"India J Clin Diagn Res"},{"key":"pone.0360675.ref030","article-title":"Pediatric patients in a local Nepali emergency department: Presenting complaints, triage and post-discharge mortality","volume":"7","author":"S Giri","year":"2020","journal-title":"Glob Pediatr Health"},{"key":"pone.0360675.ref031","doi-asserted-by":"crossref","first-page":"721646","DOI":"10.3389\/fped.2021.721646","article-title":"Critically Ill children in a swiss pediatric emergency department with an interdisciplinary approach: A prospective cohort study","volume":"9","author":"L Simma","year":"2021","journal-title":"Front Pediatr"},{"key":"pone.0360675.ref032","article-title":"Part 8: Pediatric advanced life support: 2025 American heart association and American academy of pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"152","author":"JJ Lasa","year":"2025","journal-title":"Circulation"},{"issue":"06","key":"pone.0360675.ref033","first-page":"472","article-title":"Analysis of disease spectrum in PICU of Shengjing hospital of China medical university from 2005 to 2012","volume":"15","author":"J Li","year":"2013","journal-title":"Chin J Contemp Pediat"},{"issue":"10","key":"pone.0360675.ref034","first-page":"788","article-title":"Emergency intensive care patients with clinical data were retrospectively analyzed research","volume":"25","author":"C Li","year":"2018","journal-title":"J Ped Emerg Med China"},{"key":"pone.0360675.ref035","first-page":"74","article-title":"Analysis of disease spectrum of 2138 pediatric intensive care unit patients in Guiyang","volume":"8","author":"J Zhao","year":"2021","journal-title":"Chinese Med Rec"},{"issue":"3","key":"pone.0360675.ref036","article-title":"Epidemiology of pediatric critical illness in a population-based birth cohort in Olmsted county, MN","volume":"18","author":"SS Crow","year":"2017","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"pone.0360675.ref037","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s12887-023-04175-y","article-title":"Etiological and clinical characteristics of severe pneumonia in pediatric intensive care unit (PICU)","volume":"23","author":"D Chen","year":"2023","journal-title":"BMC Pediatr"},{"issue":"5","key":"pone.0360675.ref038","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/INF.0000000000003068","article-title":"Seizure in children under five presenting with pneumonia in a critical care ward in Bangladesh: Prevalence, associated factors, and outcome","volume":"40","author":"Sharifuzzaman","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0360675.ref039","doi-asserted-by":"crossref","first-page":"123360","DOI":"10.1016\/j.lfs.2024.123360","article-title":"Research progress on pathogenesis and treatment of febrile seizures","volume":"362","author":"C Wu","year":"2025","journal-title":"Life Sci"},{"key":"pone.0360675.ref040","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-076814","article-title":"Reducing unnecessary investigations in paediatric seizures in the emergency department","volume":"385","author":"D Schonfeld","year":"2024","journal-title":"BMJ"},{"issue":"10503","key":"pone.0360675.ref041","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/S0140-6736(25)00773-1","article-title":"Childhood epilepsy","volume":"406","author":"RN Menon","year":"2025","journal-title":"Lancet"},{"issue":"1","key":"pone.0360675.ref042","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053451","article-title":"Characteristics and management of adolescents attending the ED with fever: A prospective multicentre study","volume":"12","author":"D Borensztajn","year":"2022","journal-title":"BMJ Open"},{"issue":"06","key":"pone.0360675.ref043","first-page":"452","article-title":"Clinical analysis of 8 cases of diquat poisoning in children and review of literature","volume":"43","author":"X Wang","year":"2020","journal-title":"J Clin Pediat"},{"key":"pone.0360675.ref044","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ajem.2025.12.019","article-title":"Clinical profiles and demographics of suicide attempts in early-to-mid adolescents in emergency departments: A retrospective study","volume":"101","author":"W Wang","year":"2026","journal-title":"Am J Emerg Med"},{"key":"pone.0360675.ref045","doi-asserted-by":"crossref","DOI":"10.1016\/j.jadohealth.2012.04.016","article-title":"Reducing the burden of depression in youth: What are the implications of neuroscience and genetics on policies and programs?","volume":"52","author":"V Patel","year":"2013","journal-title":"J Adolesc Health"},{"key":"pone.0360675.ref046","first-page":"259","article-title":"Children\u2019s accidental injury, 1948 cases of emergency clinical characteristics analysis","author":"J Hu","year":"2020","journal-title":"J Pract Clin J"},{"issue":"1","key":"pone.0360675.ref047","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1146\/annurev-virology-012420-022445","article-title":"Seasonality of respiratory viral infections","volume":"7","author":"M Moriyama","year":"2020","journal-title":"Annu Rev Virol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360675","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:45:33Z","timestamp":1791567933000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360675"}},"subtitle":[],"editor":[{"given":"Mabel Kamweli","family":"Aworh","sequence":"first","affiliation":[{"name":"Fayetteville State University","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":47,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360675","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}