Evidence Based Outcomes Center, Texas Children’s Hospital, Houston, Texas 77030, USA.
Pediatrics. 2011 Feb;127(2):e480-8. doi: 10.1542/peds.2010-3099. Epub 2011 Jan 17.
Acute chest syndrome (ACS) is a leading cause of hospitalization and death of children with sickle cell disease (SCD). An evidence-based ACS/SCD guideline was established to standardize care throughout the institution in February 2008. However, by the summer of 2009 use of the guideline was inconsistent, and did not seem to have an impact on length of stay. As a result, an implementation program was developed.
This quality-improvement project evaluated the influence of the development and implementation of a clinical practice guideline for children with SCD with ACS or at risk for ACS on clinical outcomes.
Clinical outcomes of 139 patients with SCD were evaluated before and after the development of the implementation program. Outcomes included average length of stay, number of exchange transfusions, average cost per SCD admission, and documentation of the clinical respiratory score and pulmonary interventions.
Average length of stay decreased from 5.8 days before implementation of the guideline to 4.1 days after implementation (P = .033). No patients required an exchange transfusion. Average cost per SCD admission decreased from $30 359 before guideline implementation to $22 368. Documentation of the clinical respiratory score increased from 31.0% before implementation to 75.5%, which is an improvement of 44.5% (P < .001). Documentation of incentive spirometry and positive expiratory pressure increased from 23.3% before implementation to 50.4%, which is an improvement of 27.1% (P < .001).
Implementation of a guideline for children with SCD with ACS or at risk for ACS improved outcomes for patients with SCD.
急性胸部综合征（ACS）是导致镰状细胞病（SCD）患儿住院和死亡的主要原因。为了规范整个机构的护理，我们于 2008 年 2 月制定了基于循证医学的 ACS/SCD 指南。然而，到 2009 年夏天，该指南的使用并不一致，并且似乎对住院时间没有影响。因此，我们制定了实施计划。
本质量改进项目评估了为患有 ACS 或有 ACS 风险的 SCD 儿童制定和实施临床实践指南对临床结果的影响。
在制定实施计划前后，对 139 例 SCD 患儿的临床结果进行了评估。结果包括平均住院时间、换血次数、SCD 入院平均费用以及临床呼吸评分和肺部干预的记录情况。
在实施指南后，平均住院时间从实施前的 5.8 天减少到 4.1 天（P =.033）。没有患者需要换血。SCD 入院的平均费用从实施前的 30359 美元降至 22368 美元。临床呼吸评分的记录从实施前的 31.0%增加到 75.5%，提高了 44.5%（P <.001）。激励性肺活量计和呼气正压的记录从实施前的 23.3%增加到 50.4%，提高了 27.1%（P <.001）。
为患有 ACS 或有 ACS 风险的 SCD 患儿实施指南可改善 SCD 患儿的预后。
