Original Article

Do We Know Where They Go? Obtaining Travel History in Pediatric Patients

Authors: Pranaya H. Chilukuri, MD, MPH, Mary Orr, MD, MPH, Shaundra Blakemore, MD, Meghan E. Hofto, MD, MPH


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.

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1. Price VA, Smith RA, Douthwaite S, et al. General physicians do not take adequate travel histories. J Travel Med 2011;18:271–274.
2. UNWTO. UNWTO Annual Report 2017. https://www.e-unwto.org/doi/abs/ 10.18111/9789284419807. Accessed February 28, 2020.
3. Crowell CS, Stamos JK. Evaluation of fever after international travel. Pediatr Ann 2011;40:39–45.
4. Hagmann S, Neugebauer R, Schwartz E, et al. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics 2010;125:e1072–e1080.
5. Hagmann SHF, Han PV, Stauffer WM, et al. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract 2014;31:678–687.
6. Cossar JH, Reid D, Fallon RJ, et al. A cumulative review of studies on travellers, their experience of illness and the implications of these findings. J Infect 1990;21:27–42.
7. Leuthard D, Berger C, Staubli G, et al. Management of children with travel-related illness evaluated in a pediatric emergency room. Pediatr Infect Dis J 2015;34:1279–1282.
8. Kyriacou DN, Spira AM, Talan DA, et al. Emergency department presentation and misdiagnosis of imported falciparum malaria. Ann Emerg Med 1996;27:696–699.
9. Halbert J, Shingadia D, Zuckerman JN. Fever in the returning child traveller: approach to diagnosis and management. Arch Dis Child 2014;99:938–943.
10. Beeching NJ, Bates I. Always take a travel history in eosinophilia. BMJ 2011;342:d3688.
11. Hon KL. Severe respiratory syndromes: travel history matters. Travel Med Infect Dis 2013;11:285–287.
12. Goldman-Yassen AE, Mony VK, Arguin PM, et al. Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria. Pediatr Emerg Care 2016;32:227–231.
13. Flores MS, Hickey PW, Fields JH, et al. A “syndromic” approach for diagnosing and managing travel-related infectious diseases in children. Curr Prob Pediatr Adolesc Health Care 2015;45:231–243.
14. Blakemore S, Hofto ME, Shah N, et al. Travel histories in children: how well do interns and medical students do? South Med J 2020;113:432–437.
15. Cromartie J. Rural-urban commuting area codes. Economic Research Service, U.S. Department of Agriculture. https://www.ers.usda.gov/dataproducts/rural-urban-commuting-area-codes.aspx. Accessed February 24, 2021.
16. Feudtner C, Feinstein JA, Zhong W, et al. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.
17. Fink D,Wani RS, Johnston V. Fever in the returning traveller. BMJ 2018;360:j5773.
18. US State Department, Bureau of Consular Affairs. Reports and statistics: U. S. passports. https://travel.state.gov/content/travel/en/about-us/reports-andstatistics.html. Accessed February 18, 2020.
19. Alabama Department of Public Health. Infectious disease and outbreaks: case counts. https://www.alabamapublichealth.gov/infectiousdiseases/cases. html. Accessed February 21, 2020.
20. Han CTJ, Flaherty G. Profile of travelers with preexisting medical conditions attending a specialist travel medicine clinic in Ireland. J Travel Med 2015;22: 312–317.