Paediatric Emergency Department, Paris 5 University, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France.
Eur J Pediatr. 2011 Sep;170(9):1151-7. doi: 10.1007/s00431-011-1428-3. Epub 2011 Feb 22.
We tested the hypothesis that application of the principles learned from the European Paediatric Life Support (EPLS) course improves child health assessment and care. In a retrospective study, residents from five paediatric emergency departments were included. For each of them, we analysed five medical records of infants and children suffering from diarrhoea; three were in ambulatory care and two were in-hospital care with IV hydration. Two independent observers analysed the records using a standardized checklist of 14 clinical points, as well as three items to evaluate the adequacy of treatment according to hydration status. Agreement between readers was evaluated the kappa coefficient of concordance. Statistical associations between each item and the EPLS course status was assessed by logistic regression taking into account the clustered data structure. Fifty residents and 240 medical records were included. Twenty-six residents were EPLS trained (intervention group) and 24 residents were not (control group). The results of the analyses of the medical records by the observers were concordant (kappa >0.91). Medical records in the intervention group contained more clinical information on circulatory status (P < 0.0001). Residents in the intervention group prescribed goal-directed therapy more often (P = 0.006). For children with shock, they administered volume resuscitation (P = 0.01) with goal-directed therapy more often (P = 0.003). This is the first evaluation of an educational program focusing on the actions of "learners" in the clinical environment. Our findings highlight that the EPLS course is associated with a better clinical analysis of hydration and circulation status as well as with goal-directed therapy.
我们检验了一个假设，即应用欧洲儿科生命支持（EPLS）课程中学到的原则可以改善儿童健康评估和护理。在一项回顾性研究中，我们纳入了来自五个儿科急诊部门的住院医师。对于每一位住院医师，我们分析了 5 份患有腹泻的婴儿和儿童的病历记录；其中 3 份为门诊治疗，2 份为静脉补液的住院治疗。两名独立观察者使用标准化检查表中的 14 个临床要点以及 3 个评估根据补液状态的治疗是否充分的项目，对记录进行了分析。读者之间的一致性通过一致性kappa 系数进行评估。考虑到聚类数据结构，通过逻辑回归评估了每个项目与 EPLS 课程状态之间的统计学关联。共纳入了 50 名住院医师和 240 份病历记录。26 名住院医师接受过 EPLS 培训（干预组），24 名住院医师未接受过培训（对照组）。观察者对病历记录的分析结果是一致的（kappa >0.91）。干预组的病历记录中包含更多有关循环状态的临床信息（P < 0.0001）。干预组的住院医师更常开具目标导向治疗（P = 0.006）。对于休克患儿，他们更常给予容量复苏（P = 0.01）和目标导向治疗（P = 0.003）。这是首次评估以临床环境中的“学习者”行动为重点的教育计划。我们的研究结果表明，EPLS 课程与更好的临床评估补液和循环状态以及目标导向治疗相关。
