Chen Esther H, Cho Christine S, Shofer Frances S, Mills Angela M, Baren Jill M
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
Pediatr Emerg Care. 2007 Nov;23(11):774-8. doi: 10.1097/PEC.0b013e318159ffef.
We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of critically ill patients in a high-volume children's hospital emergency department (ED).
Retrospective chart review of resident-patient encounters during a 1-year period using a patient tracking system. Critically ill patients included those who were triaged as "critical," died in the ED, or admitted to the intensive care unit. Descriptive data are presented as means +/- SD, frequencies, and percentages. Analysis of variance was used for continuous data and the chi test for categorical data.
A total of 3048 (4.2% of the total ED volume) critically ill patients with a mean age of 6 (+/- 5.6) years were evaluated. One hundred four emergency medicine (EM) residents were involved in the care of 903 (30%), 136 pediatric residents managed 2003 (65%), and 36 family medicine residents managed 142 (5%) critically ill patients. There was no significant difference in the mean age of evaluated patients compared by type of training program. On average, EM residents evaluated 5 patients per 10 shifts compared with pediatric residents ([9 patients per 10 shifts] P < 0.0001). Unlike pediatric residents, the number of patients cared for by EM or family medicine residents did not increase with the level of resident training. Sixty-seven life-saving procedures were performed, of which 32 (48%) were cardiopulmonary resuscitations and 35 (52%) were intubations.
Pediatric and nonpediatric residents who rotate through a high-volume children's hospital ED are exposed to a very low number of critically ill children. Other educational formats, such as mock resuscitations or standardized patient encounters, may be required to correct this deficit.
我们推测，在一家高流量儿童医院急诊科（ED），非儿科和儿科住院医师接触到的危重症患者比例极低。
使用患者追踪系统对1年期间住院医师与患者的接触情况进行回顾性病历审查。危重症患者包括那些被分诊为“危急”、在急诊科死亡或入住重症监护病房的患者。描述性数据以均值±标准差、频数和百分比表示。对连续数据采用方差分析，对分类数据采用卡方检验。
共评估了3048例危重症患者（占急诊总量的4.2%），平均年龄为6（±5.6）岁。104名急诊医学（EM）住院医师参与了903例（30%）危重症患者的护理，136名儿科住院医师管理了2003例（65%），36名家庭医学住院医师管理了142例（5%）危重症患者。按培训项目类型比较，所评估患者的平均年龄无显著差异。平均而言，EM住院医师每10个班次评估5例患者，而儿科住院医师为每10个班次评估9例患者（P<0.0001）。与儿科住院医师不同，EM或家庭医学住院医师护理的患者数量并未随着住院医师培训水平的提高而增加。共实施了67项挽救生命的操作，其中32项（48%）为心肺复苏，35项（52%）为插管。
在高流量儿童医院急诊科轮转的儿科和非儿科住院医师接触到的危重症儿童数量极少。可能需要其他教育形式，如模拟复苏或标准化患者接触，来弥补这一不足。
