Geurts Dorien, de Vos-Kerkhof Evelien, Polinder Suzanne, Steyerberg Ewout, van der Lei Johan, Moll Henriëtte, Oostenbrink Rianne
Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands.
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
Eur J Pediatr. 2017 Feb;176(2):173-181. doi: 10.1007/s00431-016-2819-2. Epub 2016 Dec 8.
Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures.
Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.
急性胃肠炎（AGE）是幼儿前往急诊科（ED）就诊的最常见原因之一。我们旨在评估（1）护士指导的临床决策支持系统用于AGE患儿补液治疗的可行性，以及（2）与主治医师的常规护理相比，该系统对诊断、治疗和费用的影响。在荷兰伊拉斯姆斯医学中心 - 索菲亚儿童医院急诊科对222名年龄在1个月至5岁的儿童进行了一项随机对照试验（2010 - 2012年）。结果包括（1）可行性，通过护士的依从性来衡量，以及（2）在急诊科的住院时间（LOS）、诊断测试数量、治疗、随访和费用。由于急诊科后体重测量失败，我们无法评估体重差异作为脱水的衡量指标。干预组（N = 113）和常规护理组（N = 109）的患者特征具有可比性。临床决策支持系统的实施证明了较高的依从率。口服ORS（口服补液盐）的标准化使用从52%显著增加到65%（RR 2.2，95%CI 1.09 - 4.31，p < 0.05）。我们在其他结果指标上未观察到差异。
护士指导的临床决策支持系统用于AGE患儿补液治疗的实施显示出高依从性，并增加了ORS的标准化使用，在其他结果指标上无差异。已知信息：• 急性胃肠炎是儿科急诊科最常遇到的问题之一。• 指南提倡对轻度至中度脱水的儿童进行标准化口服治疗，但在临床实践中似乎很少应用。新内容：• 护士指导的临床决策支持系统用于幼儿AGE治疗的实施显示出良好的可行性，与常规护理相比，导致轻度至中度脱水儿童的ORS使用更加标准化。• 鉴于在急诊护理环境中进行研究面临的挑战，急诊科应经验丰富且设备充足，尤其是在高峰时段。
