口服摄入物质的幼儿家庭发起的非医疗干预措施的比较结果分析

Comparative outcome analysis of home-initiated non-medical interventions among toddlers with orally ingested substances.

作者信息

Alanazi Menyfah Q, Al-Jeraisy Majed I, Salam Mahmoud

机构信息

Drug Policy and Economic Center, Riyadh, Saudi Arabia.

King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.

出版信息

Ital J Pediatr. 2015 Sep 15;41:63. doi: 10.1186/s13052-015-0170-2.

DOI:10.1186/s13052-015-0170-2

PMID:26373531

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4570254/

Abstract

BACKGROUND

Poison management guidelines recommend contacting or visiting poison centers directly after exposure. However, some parents initiated non-medical interventions on their children before visiting these centers. Aim was to evaluate the clinical and hospital outcomes of such practices among toddlers with orally ingested medication or chemical substances at a tertiary care facility.

METHODS

Retrospective cohort, based on four-arm outcome analysis. Exposures were gender, age, body mass index, arrival time to facility (hours) presented in Median [Interquartile range]. Clinical outcomes were vital signs, physical examination, diagnostic tests; Hospital outcomes were in-hospital admission, length of hospital stay (hours) presented in Median [Interquartile range], hospital cost ($US). Bivariate analysis (nonparametric tests), binary logistic/linear regression were conducted. Significance at p < 0.05.

RESULTS

Between 2009-2011, 165 (all previously healthy) toddlers were (Males = 58 %, females = 42 %) and had normal weights in 70 %. Witnessed incidents were in 85 %. Two control groups [Medication (control) = 72, Chemical (control) = 48] directly visited the facility after incident, while two intervention groups [Medication (intervention) = 27, Chemical (intervention) = 18] received orally administered water, salt/sugar solutes, milk/yogurt, lemon juice and/or manually induced vomiting before the visit. Abnormal clinical outcomes in total were in vital signs = 15 %, physical examination = 42 % and diagnostic tests = 26 %; hospital outcomes were admission = 16 %, length of stay range (2 hours-7.5 days), cost range (667-11,500). Bivariate analysis: Length of stay in Medication (intervention) = 9[5.4-12.0] hours significantly higher than Medication (control) = 5[2.7-7.5] hours, p = 0.003; abnormal physical examination in Chemical (intervention) = 77.8 % significantly higher than Chemical (control) = 37.5 %, p = 0.004. In regression: intervention significantly increased length of stay (t = 0.213, adj. P = 0.035); lower weight toddlers were at higher risk of admission (Beta = -0.51, adj. P = 0.018); delayed arrival time significantly increased abnormal physical examination (Beta = 0.29, adj. P = 0.003). No significant control/intervention group differences regarding abnormal vital signs (adj. P = 0.148), physical examination (adj. P = 0.781), diagnostic tests (adj. P = 0.285), admission (adj. P = 0.499), and cost (adj. P = 0.102).

CONCLUSION

Home-initiated non-medical interventions didn't improve the clinical and hospital outcomes. It has delayed the arrival time to emergency department, which added the risk of encountering abnormal physical examination, and in return increased the average length of hospital stay.

摘要

背景

中毒管理指南建议在接触毒物后直接联系或前往中毒控制中心。然而，一些家长在带孩子前往这些中心之前就采取了非医疗干预措施。目的是评估在一家三级医疗机构中，口服药物或化学物质的幼儿采取此类措施后的临床和住院结局。

方法

基于四臂结局分析的回顾性队列研究。暴露因素包括性别、年龄、体重指数、到达医疗机构的时间（小时），以中位数[四分位间距]表示。临床结局包括生命体征、体格检查、诊断检查；住院结局包括住院情况、住院时间（小时），以中位数[四分位间距]表示，以及住院费用（美元）。进行双变量分析（非参数检验）、二元逻辑/线性回归分析。显著性水平为p < 0.05。

结果

2009年至2011年期间，165名（均为此前健康的）幼儿（男性占58%，女性占42%），70%体重正常。85%的事件有目击者。两个对照组[药物（对照）组 = 72例，化学物质（对照）组 = 48例]在事件发生后直接前往医疗机构，而两个干预组[药物（干预）组 = 27例，化学物质（干预）组 = 18例]在前往之前口服了水、盐/糖溶液、牛奶/酸奶、柠檬汁和/或进行了催吐。总体异常临床结局为生命体征异常占15%，体格检查异常占42%，诊断检查异常占26%；住院结局为住院率16%，住院时间范围为（2小时至7.5天），费用范围为（667美元至11,500美元）。双变量分析：药物（干预）组的住院时间为9[5.4 - 12.0]小时，显著长于药物（对照）组的5[2.7 - 7.5]小时，p = 0.003；化学物质（干预）组的体格检查异常率为77.8%，显著高于化学物质（对照）组的37.5%，p = 0.004。回归分析显示：干预显著增加了住院时间（t = 0.213，校正P = 0.035）；体重较轻的幼儿住院风险更高（β = -0.51，校正P = 0.018）；到达时间延迟显著增加了体格检查异常的发生率（β = 0.29，校正P = 0.003）。在异常生命体征（校正P = 0.148）、体格检查（校正P = 0.781）、诊断检查（校正P = 0.285）、住院情况（校正P = 0.499）和费用（校正P = 0.102）方面，对照组和干预组之间无显著差异。