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Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study
  1. Rasha D Sawaya1,
  2. Cynthia Wakil1,
  3. Sami Shayya1,
  4. Moustafa Al Hariri1,
  5. Alik Dakessian1,
  6. Adonis Wazir1,
  7. Maha Makki2,
  8. Sarah Jamali1,
  9. Hani Tamim2,3
  1. 1 Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  2. 2 Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  3. 3 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  1. Correspondence to Dr Hani Tamim, American University of Beirut, Beirut 1107 2020, Lebanon; htamim{at}


Objective To investigate the impact of Ramadan on patient characteristics, diagnoses and metrics in the paediatric emergency department (PED).

Design Retrospective cross-sectional study.

Setting PED of a tertiary care centre in Lebanon.

Patients All paediatric patients.

Exposure Ramadan (June 2016 and 2017) versus the months before and after Ramadan (non-Ramadan).

Main outcome measures Patient and illness characteristics and PED metrics including peak patient load; presentation timings; length of stay; and times to order tests, receive samples and report results.

Results We included 5711 patients with mean age of 6.1±5.3 years and 55.4% males. The number of daily visits was 28.3±6.5 during Ramadan versus 31.5±7.3 during non-Ramadan (p=0.004). The peak time of visits ranged from 18:00 to 22:00 during non-Ramadan versus from 22:00 to 02:00 during Ramadan. During Ramadan, there were significantly more gastrointestinal (GI) and trauma-related complaints (39.0% vs 35.4%, p=0.01 and 2.9% vs 1.8%, p=0.005). The Ramadan group had faster work efficiency measures such as times to order tests (21.1±21.3 vs 24.3±28.1 min, p<0.0001) and to collect samples (50.7±44.5 vs 54.8±42.6 min, p=0.03).

Conclusions Ramadan changes presentation patterns, with fewer daily visits and a later peak time of visits. Ramadan also affects illness presentation patterns with more GI and trauma cases. Fasting times during Ramadan did not affect staff work efficiency. These findings could help EDs structure their staffing to optimise resource allocation during Ramadan.

  • epidemiology
  • health services research
  • statistics
  • outcome and process assessment
  • healthcare

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  • Contributors RDS, SS and HT conceived and designed the study. RDS, SS and CW coordinated the study throughout. RDS and HT had full access to all the data in the study and take responsibility for the integrity of the data. SS and CW helped with proposal drafting and data extraction. CW, AW, MAH, SS, AD and SJ collected the data. HT and MM analysed the data. HT, MM, CW and RDS interpreted the data. All authors drafted and critically revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the AUBMC Institutional Review Board under the protocol number (BIO-2017-0414).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All relevant data are available on reasonable request by emailing the corresponding author. The dataset as is now considered for secondary data analysis.