Hamm Michele P, Osmond Martin, Curran Janet, Scott Shannon, Ali Samina, Hartling Lisa, Gokiert Rebecca, Cappelli Mario, Hnatko Gary, Newton Amanda S
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Pediatr Emerg Care. 2010 Dec;26(12):952-62. doi: 10.1097/PEC.0b013e3181fe9211.
In this systematic review, we evaluated the effectiveness of emergency department (ED)-based management interventions for mental health presentations with an aim to provide recommendations for pediatric care.
A search of electronic databases, references, key journals, and conference proceedings was conducted, and primary authors were contacted. Experimental and observational studies that evaluated ED crisis care with pediatric and adult patients were included. Adult-based studies were evaluated for potential translation to pediatric investigation. Pharmacological-based studies were excluded. Inclusion screening, study selection, and methodological quality were assessed by 2 independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Presentation of study outcomes included odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CI). Meta-analysis was deferred due to clinical heterogeneity in intervention, patient population, and outcome.
Twelve observational studies were included in the review with pediatric (n = 3), and adult or unknown (n = 9) aged participants. Pediatric studies supported the use of specialized care models to reduce hospitalization (OR, 0.45; 95% CI, 0.33-0.60), return ED visits (OR, 0.60; 95% CI, 0.28-1.25), and length of ED stay (MD, -43.1 minutes; 95% CI, -63.088 to -23.11 minutes). In an adult study, reduced hospitalization was reported in a comparison of a crisis intervention team to standard care (OR, 0.59; 95% CI, 0.43-0.82). Five adult-based studies assessed triage scales; however, little overlap in the scales investigated, and the outcomes measured limited comparability and generalizability for pediatrics. In a comparison of a mental health scale to a national standard, a study demonstrated reduced ED wait (MD, -7.7 minutes; 95% CI, -12.82 to -2.58 minutes) and transit (MD, -17.5 minutes; 95% CI, -33.00 to -1.20 minutes) times. Several studies reported a shift in triage scores of psychiatric patients dependent on the scale or nurse training (psychiatric vs emergency), but linkage to system- or patient-based outcomes was not made, limiting clinical interpretation.
Pediatric studies have demonstrated that the use of specialized care models for mental health care can reduce hospitalization, return ED visits, and length of ED stay. Evaluation of these models using more rigorous study designs and the inclusion of patient-based outcomes will improve this evidence base. Adult-based studies provided recommendations for pediatric research including a focus on triage and restraint use.
在本系统评价中，我们评估了基于急诊科（ED）的心理健康就诊管理干预措施的有效性，旨在为儿科护理提供建议。
对电子数据库、参考文献、重点期刊和会议论文集进行了检索，并联系了第一作者。纳入了评估儿科和成人患者ED危机护理的实验性和观察性研究。对基于成人的研究进行评估，以确定其是否有可能转化为儿科研究。排除基于药理学的研究。由2名独立评审员评估纳入筛选、研究选择和方法学质量。一名评审员提取数据，另一名评审员检查数据的完整性和准确性。研究结果的呈现包括优势比（OR）和平均差（MD）以及95%置信区间（CI）。由于干预措施、患者群体和结果存在临床异质性，故未进行荟萃分析。
该评价纳入了12项观察性研究，参与者年龄为儿科（n = 3）、成人或年龄未知（n = 9）。儿科研究支持使用专门的护理模式来减少住院率（OR，0.45；95%CI，0.33 - 0.60）、再次到ED就诊率（OR，0.60；95%CI，0.28 - 1.25）以及ED住院时间（MD，-43.1分钟；95%CI，-63.088至-23.11分钟）。在一项成人研究中，与标准护理相比，危机干预团队可降低住院率（OR，0.59；95%CI，0.43 - 0.82）。五项基于成人的研究评估了分诊量表；然而，所研究的量表几乎没有重叠，且所测量的结果在儿科方面的可比性和可推广性有限。在一项将心理健康量表与国家标准进行比较的研究中，结果显示ED等待时间（MD，-7.7分钟；95%CI，-12.82至-2.58分钟）和转运时间（MD，-17.5分钟；95%CI，-33.00至-1.20分钟）有所减少。多项研究报告称，精神病患者的分诊分数会因量表或护士培训（精神科与急诊科）而发生变化，但未建立与系统或患者相关结果的联系，限制了临床解释。
儿科研究表明，使用专门的心理健康护理模式可减少住院率、再次到ED就诊率以及ED住院时间。采用更严格的研究设计对这些模式进行评估，并纳入基于患者的结果，将改善这一证据基础。基于成人的研究为儿科研究提供了建议，包括关注分诊和约束措施的使用。
