Cruz Andrea T, Williams Eric A, Graf Jeanine M, Perry Andrew M, Harbin Devin E, Wuestner Elizabeth R, Patel Binita
Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Pediatr Emerg Care. 2012 Sep;28(9):889-94. doi: 10.1097/PEC.0b013e318267a78a.
This study aimed to create and analyze the performance of an automated triage tool alerting triage nursing staff and physicians to an abnormal heart rate consistent with septic shock in a pediatric emergency department.
A computerized best-practice alert (BPA) triage system corrected heart rate for temperature (5 beats per minute for each 1°F above 100°F or 9.6-10 beats per minute for each 1°C > 36°C) and alarmed on tachycardia. If patients appeared ill and/or had medical comorbidities predisposing them to sepsis, a "shock protocol" was activated. Sensitivity was calculated for patients clinically diagnosed with shock during the study period.
During the study period (February to August 2010), the BPA was triggered in 4552 (11.5%) of 39,697 visits. Mean age was 5.4 years (range, 18 days to 18 years); 53% were female. The tool was 81% sensitive in identifying the 210 patients with shock. Missed patients were more likely to be previously healthy (odds ratio, 2.7; 95% confidence interval, 1.2-6.2), younger (5.7 vs 8.7 years, P = 0.004), and less likely to have a malignancy (odds ratio, 0.38; 95% confidence interval, 0.2-0.8). The tool was 89% specific; positive and negative predictive values were 4% and 99.9%, respectively.
The BPA-automated sensitive triage tool, based solely on initial temperature and heart rate, led to the identification of most children with septic shock, even before clinical acumen and laboratory values were incorporated into the diagnostic algorithm.
本研究旨在创建并分析一种自动分诊工具的性能，该工具可提醒儿科急诊科的分诊护理人员和医生注意与脓毒性休克相符的异常心率。
一种计算机化的最佳实践警报（BPA）分诊系统根据体温校正心率（华氏温度高于100°F时，每升高1°F心率增加5次/分钟；或摄氏温度高于36°C时，每升高1°C心率增加9.6 - 10次/分钟），并在心动过速时发出警报。如果患者看起来病情严重和/或有易患败血症的合并症，则启动“休克方案”。计算研究期间临床诊断为休克的患者的敏感性。
在研究期间（2010年2月至8月），39697次就诊中有4552次（11.5%）触发了BPA。平均年龄为5.4岁（范围为18天至18岁）；53%为女性。该工具在识别210例休克患者方面的敏感性为81%。漏诊的患者更可能既往健康（优势比为2.7；95%置信区间为1.2 - 6.2）、年龄较小（5.7岁对8.7岁，P = 0.004）且患恶性肿瘤的可能性较小（优势比为0.38；95%置信区间为0.2 - 0.8）。该工具的特异性为89%；阳性预测值和阴性预测值分别为4%和99.9%。
仅基于初始体温和心率的BPA自动敏感分诊工具，即使在临床敏锐度和实验室值纳入诊断算法之前，也能识别出大多数脓毒性休克儿童。
