Israel Medical Association Journal

Takotsubo cardiomyopathy (TC) is a temporary and reversible hypokinesia of the left ventricle's apical area of the heart mediating systolic abnormality. This phenomenon resembles myocardial infarction but without coronary artery disease (CAD) [1]. The prevalence is 1.0–2.5% annually. Most of the patients with TC are postmenopausal women [2]. Over-stimulation of the sympathetic system, microvascular and myocardial tissue metabolism abnormality, and coronary artery vasospasm are linked to TC [2]. The criterion of the diagnosis consists of temporary hypokinesis or akinesis in left ventricle segments with or without apical involvement, electrocardiogram (ST-segment elevation and/or T-wave inversion), or significant elevation of serum cardiac troponins and non-existence of pheochromocytoma or myocarditis [3]. The pathognomonic finding of TC during echocardiography is apical ballooning involving the left ventricle. This unique morphology was reported to present in 75% of patients [2,3]. In 25% of patients. The morphology was reported to follow a mid-ventricular ballooning pattern due to mid-LV akinesis with no disturbance of apical and basal contraction [2,3].

Background: Pediatric urolithiasis is relatively uncommon and is generally associated with predisposing anatomic or metabolic abnormalities. In the adult population, emergency department (ED) admissions have been associated with an increase in ambient temperature. The same association has not been evaluated in the pediatric population.

Objectives: To analyze trends in ED admissions due to renal colic in a pediatric population (≤ 18 years old) and to assess the possible effect of climate on ED admissions.

Methods: We conducted a retrospective, multicenter cohort study, based on a computerized database of all ED visits due to renal colic in pediatric patients. The study cohort presented with urolithiasis on imaging during their ED admission. Exact climate data was acquired through the Israeli Meteorological Service (IMS).

Results: Between January 2010 and December 2020, 609 patients, ≤ 18 years, were admitted to EDs in five medical centers with renal colic: 318 males (52%), 291 females (48%). The median age was 17 years (IQR 9–16). ED visits oscillated through the years, peaking in 2012 and 2018. A 6% downward trend in ED admissions was noted between 2010 and 2020. The number of ED admissions in the different seasons was 179 in autumn (30%), 134 in winter (22%), 152 in spring (25%), and 144 in summer (23%) (P = 0.8). Logistic regression multivariable analysis associated with ED visits did not find any correlation between climate parameters and ED admissions due to renal colic in the pediatric population.

Conclusions: ED admissions oscillated during the period investigated and had a downward trend. Unlike in the adult population, rates of renal colic ED admissions in the pediatric population were not affected by seasonal changes or rise in maximum ambient temperature.