Goh Adrian Yu-Teik, Abdel-Latif Mohd El-Amin, Lum Lucy Chai-See, Abu-Bakar Mohd Nazir
Pediatric Intensive Care Unit, University Malaya Medical Center, 50603 Kuala Lumpur, Malaysia.
Intensive Care Med. 2003 Jan;29(1):97-102. doi: 10.1007/s00134-002-1534-9. Epub 2002 Dec 4.
Lack of direct access to tertiary pediatric intensive care services in rural hospitals may be associated with poorer outcome among critically ill children. Inter-hospital transport by non-specialized teams may also lead to increased morbidity and even mortality. We therefore studied the outcome of children with different accessibility to tertiary pediatric care in Malaysia.
We prospectively compared the Pediatric Risk of Mortality (PRISM II) adjusted standardized mortality ratio (SMR), unanticipated deaths and length of stay of 131 patients transported from rural hospitals (limited access) with 215 transferred from the casualty wards or other in-hospital wards (direct access) to a tertiary pediatric ICU.
The transported patients were younger than the in-hospital patients (median age 1.0 versus 6.0 months, p=0.000) and were more likely to have respiratory diseases. Other baseline characteristics did not differ significantly. Differences in access to tertiary intensive care from community hospitals was associated with an extended median length of stay (4.0 versus 2.0 days, p=0.000) but did not affect SMR (0.92 versus 0.84, rate ratio 1.09, 95% CI 0.57-2.01; p=0.348) or percentage of unexpected deaths (4.8% versus 2.8%, p=0.485). The adjusted odds ratio for mortality (1.7, 95% CI 0.7-4.3) associated with transfer was not statistically significant (p=0.248).
The outcome of critically ill children transferred from community hospitals did not differ from that of those who develop ICU needs in the wards of a tertiary center, despite being transported by non-specialized teams. Outcome was not affected by initial inaccessibility to intensive care if the children finally received care in a tertiary center.
农村医院无法直接获得三级儿科重症监护服务可能与危重症儿童预后较差有关。由非专业团队进行的院际转运也可能导致发病率增加甚至死亡。因此，我们研究了马来西亚不同程度获得三级儿科护理服务的儿童的预后情况。
我们前瞻性地比较了131例从农村医院转运（获得服务有限）的患者与215例从急诊病房或其他院内病房转运（直接获得服务）至三级儿科重症监护病房的患者的儿科死亡风险（PRISM II）调整标准化死亡率（SMR）、意外死亡情况和住院时间。
转运患者比院内患者年龄更小（中位年龄1.0个月对6.0个月，p = 0.000），且更易患呼吸系统疾病。其他基线特征无显著差异。社区医院获得三级重症监护服务的差异与中位住院时间延长有关（4.0天对2.0天，p = 0.000），但不影响SMR（0.92对0.84，率比1.09，95%CI 0.57 - 2.01；p = 0.348）或意外死亡百分比（4.8%对2.8%，p = 0.485）。与转运相关的调整后死亡比值比为1.7（95%CI 0.7 - 4.3），无统计学意义（p = 0.248）。
尽管由非专业团队转运，但从社区医院转运的危重症儿童的预后与在三级中心病房出现重症监护需求的儿童的预后并无差异。如果儿童最终在三级中心接受治疗，其预后不受最初无法获得重症监护服务的影响。
