Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA.
J Pediatr. 2011 Aug;159(2):273-7.e1. doi: 10.1016/j.jpeds.2011.01.031. Epub 2011 Mar 10.
To assess emergency department (ED) utilization and physician preparedness for infants with single ventricle (SV) physiology between stage 1 and stage 2 surgical palliation.
Records of infants with SV physiology discharged after stage I palliation between July 2006 and June 2009 were retrospectively reviewed. Next, a cross-sectional survey of registered ED physicians in Michigan was performed.
Thirty-three of 42 patients (79%) required 65 ED visits, most commonly presenting with respiratory distress (35%). Six patients died in the ED; 35 other visits resulted in hospital admission, 4 requiring urgent surgery or catheterization. Median initial hospital stay in those with ED visits was significantly longer (21 days; IQR, 17-45 days) than those without (12 days; IQR, 5.5-24 days) (P = .032). Three hundred seventy-six of 915 surveyed ED physicians responded. Most (72%) were unsure of the acceptable range of arterial oxygen saturation for these infants, and 58% felt "uncomfortable" or "worried" about their treatment. Despite these concerns, 59% deemed education in SV physiology as low priority.
Between stages I and II, infants with SV physiology utilized the ED frequently, often with high disease acuity. Most ED physicians surveyed appeared underprepared for these infants. These findings underscore the need for educational efforts aimed at increasing ED preparedness.
评估在 1 期至 2 期手术姑息治疗阶段之间，患有单心室（SV）生理功能的患儿对急诊部（ED）的利用情况和医生对其的准备情况。
回顾性分析了 2006 年 7 月至 2009 年 6 月期间接受 1 期姑息治疗后出院的 SV 生理功能患儿的记录。随后，对密歇根州注册的 ED 医生进行了横断面调查。
42 名患儿中有 33 名（79%）需要 65 次 ED 就诊，最常见的就诊原因是呼吸窘迫（35%）。6 名患儿在 ED 死亡；35 次其他就诊导致住院，其中 4 次需要紧急手术或导管插入术。有 ED 就诊的患儿初始住院中位数明显延长（21 天；IQR，17-45 天），而无 ED 就诊的患儿初始住院中位数明显较短（12 天；IQR，5.5-24 天）（P =.032）。915 名接受调查的 ED 医生中，有 376 名做出了回应。大多数（72%）医生不确定这些婴儿动脉血氧饱和度的可接受范围，58%的医生感到“不舒服”或“担心”对这些患儿的治疗。尽管存在这些担忧，但 59%的医生认为 SV 生理功能教育的优先级较低。
在 1 期和 2 期之间，患有 SV 生理功能的患儿经常使用 ED，且通常疾病严重程度较高。大多数接受调查的 ED 医生似乎对这些婴儿准备不足。这些发现强调了需要开展教育工作，以提高 ED 对 SV 患儿的准备程度。
