Ibrahim Laila F, Hopper Sandy M, Babl Franz E, Bryant Penelope A
From the *RCH@Home Department, The Royal Children's Hospital; † Murdoch Children's Research Institute; ‡Department of Pediatrics, University of Melbourne; §Emergency Department, and ¶Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
Pediatr Infect Dis J. 2016 Mar;35(3):269-74. doi: 10.1097/INF.0000000000000992.
The benefits of treating children at home or in an ambulatory setting have been well documented. We aimed to describe the characteristics and evaluate the outcomes of children with moderate/severe cellulitis treated at home with intravenous (IV) ceftriaxone via direct referral from the Emergency Department to a hospital-in-the-home (HITH) program.
Patients aged 3 months to 18 years with moderate/severe cellulitis referred from a tertiary pediatric Emergency Department to HITH from September 2012 to January 2014 were prospectively identified. Data collection included demographics, clinical features, microbiological characteristics and outcomes. To ensure home treatment did not result in inferior outcomes, these patients were retrospectively compared with patients who were hospitalized for IV flucloxacillin, the standard-of-care over the same period. The primary outcome was home treatment failure necessitating hospital admission. Secondary outcomes included antibiotic changes, complications, length of stay and cost.
Forty-one (28%) patients were treated on HITH and 103 (72%) were hospitalized. Compared with hospitalized patients, HITH patients were older (P < 0.01) and less likely to have periorbital cellulitis (P = 0.01) or fever (P = 0.04). There were no treatment failures under HITH care. The rate of antibiotic changes was similar in both groups (5% vs. 7%, P = 0.67), as was IV antibiotic duration (2.3 vs. 2.5 days, P = 0.23).
Older children with moderate/severe limb cellulitis without systemic symptoms can be treated at home. To ascertain if this practice can be applied more widely, a comparative prospective, ideally randomized, study is needed.
在家中或门诊环境中治疗儿童的益处已有充分记录。我们旨在描述通过急诊科直接转诊至家庭医院（HITH）项目在家中接受静脉注射头孢曲松治疗的中度/重度蜂窝织炎患儿的特征，并评估其治疗结果。
前瞻性确定2012年9月至2014年1月从三级儿科急诊科转诊至HITH的3个月至18岁患有中度/重度蜂窝织炎的患者。数据收集包括人口统计学、临床特征、微生物学特征和治疗结果。为确保家庭治疗不会导致较差的治疗结果，将这些患者与同期因静脉注射氟氯西林住院治疗的患者进行回顾性比较，静脉注射氟氯西林是同期的标准治疗方法。主要结局是因家庭治疗失败而需要住院。次要结局包括抗生素更换、并发症、住院时间和费用。
41名（28%）患者接受了HITH治疗，103名（72%）患者住院治疗。与住院患者相比，HITH患者年龄较大（P < 0.01），眶周蜂窝织炎（P = 0.01）或发热（P = 0.04）的可能性较小。在HITH护理下没有治疗失败的情况。两组的抗生素更换率相似（5%对7%，P = 0.67），静脉抗生素使用时间也相似（2.3天对2.5天，P = 0.23）。
没有全身症状的中度/重度肢体蜂窝织炎的大龄儿童可以在家中治疗。为确定这种做法是否可以更广泛地应用，需要进行一项比较性前瞻性研究，理想情况下是随机研究。
