Murray Ashlee Lynn, Alpern Elizabeth, Lavelle Jane, Mollen Cynthia
From the *The Children's Hospital of Philadelphia, Philadelphia, PA; and †Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Pediatr Emerg Care. 2017 Sep;33(9):e33-e37. doi: 10.1097/PEC.0000000000000960.
Young infants are often treated in emergency departments (EDs) for febrile illnesses. Any delay in care or ineffective management could lead to increased patient morbidity and mortality. A standardized ED clinical pathway may improve care for these patients. The objective of this study is to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care.
This study used a before-and-after retrospective observational study design comparing 2 separate periods: prepathway from September 2007 through August 2008 and postpathway from September 2009 through August 2010. Subjects were infants aged 56 days or younger presenting with a rectal temperature of 38.0°C or higher. Patients were excluded if they were transferred from another hospital or if they developed a fever after initial presentation.
Five hundred twenty infants were enrolled. The mean time to urine collection and time to the first antibiotic administration were reduced after pathway implementation (23-minute reduction to urine collection vs 36-minute reduction to the first antibiotic administration). There was improvement in the proportion of infants who received the pathway-specific antibiotics based on age (odds ratio, 7.2; 95% confidence interval, 4.4, 11.9) and the proportion of infants who were administered acyclovir based on pathway guidelines (odds ratio, 8.8; 95% confidence interval, 2.9-30.0).
An ED-based febrile young infant clinical pathway improved the timeliness of initiation of work-up as measured by urine collection and of therapy by an earlier administration of the first antibiotic, as well as decreased variability of care.
年幼婴儿常因发热性疾病在急诊科接受治疗。护理的任何延误或管理无效都可能导致患者发病率和死亡率上升。标准化的急诊科临床路径可能会改善对这些患者的护理。本研究的目的是评估在一家大型城市儿童医院急诊科实施的发热年幼婴儿临床路径对护理及时性和一致性的影响。
本研究采用前后回顾性观察研究设计，比较两个不同时期：2007年9月至2008年8月的路径实施前阶段和2009年9月至2010年8月的路径实施后阶段。研究对象为直肠温度达到或高于38.0°C的56日龄或更小的婴儿。如果患者是从另一家医院转来的，或者在初次就诊后出现发热，则被排除在外。
共纳入520名婴儿。路径实施后，尿液采集的平均时间和首次使用抗生素的时间缩短（尿液采集时间减少23分钟，首次使用抗生素时间减少36分钟）。根据年龄接受路径特定抗生素治疗的婴儿比例（优势比为7.2；95%置信区间为4.4至11.9）以及根据路径指南使用阿昔洛韦治疗的婴儿比例（优势比为8.8；95%置信区间为2.9至30.0）均有所提高。
基于急诊科的发热年幼婴儿临床路径改善了以尿液采集衡量的检查开始及时性和通过更早使用首次抗生素实现的治疗及时性，同时减少了护理的变异性。
