Emergency Department, Helen DeVos Children's Hospital/Michigan State University College of Human Medicine, Grand Rapids, Michigan 49503, USA.
Prehosp Emerg Care. 2012 Jan-Mar;16(1):59-66. doi: 10.3109/10903127.2011.614043. Epub 2011 Oct 14.
Medication dosing errors occur in up to 17.8% of hospitalized children. There are limited data to describe pediatric medication errors by emergency medical services (EMS) paramedics. It has been shown that paramedics have infrequent encounters with pediatric patients.
To characterize medication dosing errors in children treated by EMS.
We studied patients aged ≤11 years who were treated by paramedics from eight Michigan EMS agencies from January 2004 through March 2006. We defined a medication dosing error as ≥20% deviation from the weight-appropriate dose, as determined by the patient's reported weight in the prehospital medical record or by use of the Broselow-Luten tape (BLT). We studied errors in administering six EMS medications commonly given to children: albuterol, atropine, dextrose, diphenhydramine, epinephrine, and naloxone.
There were 5,547 children aged ≤11 years who were treated during the study period, of whom 230 (4.1%) received drugs and had a documented weight. These patients received a total of 360 medication administrations. Multiple drug administrations occurred in 73 cases. Medication dosing errors occurred in 125 of the 360 drug administrations (34.7%; 95% confidence interval [CI] 30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows: albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine 53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine overdoses was 808% ± 428%. The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% ± 27.4%.
Medications delivered in the prehospital care of children were frequently administered outside of the proper dose range when compared with patient weights recorded in the prehospital medical record. EMS systems should develop strategies to reduce pediatric medication dosing errors.
高达 17.8%的住院儿童会出现用药剂量错误。目前有关急救医疗服务（EMS）护理人员导致的儿科用药错误的数据有限。研究表明，护理人员很少接触儿科患者。
描述 EMS 治疗的儿童用药剂量错误。
我们研究了 2004 年 1 月至 2006 年 3 月期间，来自密歇根州 8 个 EMS 机构的年龄≤11 岁的患者。我们将用药剂量错误定义为，与患者在院前医疗记录中报告的体重或使用 Broselow-Luten 带（BLT）确定的体重相比，用药剂量偏差≥20%。我们研究了六类常见的儿童用药：沙丁胺醇、阿托品、葡萄糖、苯海拉明、肾上腺素和纳洛酮的用药剂量错误。
研究期间共治疗了 5547 名年龄≤11 岁的患儿，其中 230 名（4.1%）接受了药物治疗，且有记录的体重。这些患者共接受了 360 次药物治疗。73 例出现了多次药物治疗。360 次药物治疗中有 125 次（34.7%；95%置信区间[CI] 30.0，39.8）出现了用药剂量错误。相对药物剂量错误（95%CI）如下：沙丁胺醇 23.3%（18.4，29.1），阿托品 48.8%（34.3，63.5），苯海拉明 53.8%（29.1，76.8），肾上腺素 60.9%（49.9，73.9）。静脉/骨内 1:1000 肾上腺素过量的平均误差（±标准差）为 808%±428%。静脉/骨内 1:1000 肾上腺素剂量不足的平均误差（±标准差）为 35.5%±27.4%。
与院前医疗记录中记录的患者体重相比，在儿童的院前护理中给予的药物经常超出适当的剂量范围。EMS 系统应制定策略，以减少儿科用药剂量错误。
