印度急诊科发热儿童评估与管理的共识指南

Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India.

作者信息

Mahajan Prashant, Batra Prerna, Thakur Neha, Patel Reena, Rai Narendra, Trivedi Nitin, Fassl Bernhard, Shah Binita, Lozon Marie, Oteng Rockerfeller A, Saha Abhijeet, Shah Dheeraj, Galwankar Sagar

机构信息

Departments of Emergency Medicine and Pediatrics, University of Michigan (Ann Arbor, MI, USA); #Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India; $Department of Pediatrics, Hind Institute of Medical Sciences, Lucknow, India; ‡Department of Pediatrics, Division of Inpatient Medicine, University of Utah, (Salt Lake City, UT, USA); ^Department of Pediatrics, Hind Institute of Medical Sciences, Lucknow, India; £Department of Pediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur, India; @Department of Pediatrics; Division of Inpatient Medicine and Department of Epidemiology and Biostatistics, University of Utah, (Salt Lake City, UT, USA); **Departments of Emergency Medicine and Pediatrics, SUNY Downstate Medical Center, Kings County Hospital Center (Brooklyn, NY, USA); ##Department of Emergency Medicine, University of Michigan, (Ann Arbor, MI, USA); $$Department of Emergency Medicine, University of Michigan (Ann Arbor, MI, USA) and Directorate of Emergency Medicine, KomfoAnokye Teaching Hospital (Kumasi, Ghana); '‡‡Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India; and @@ Department of Emergency Medicine, University of Florida, (Jacksonville, FL, USA). Correspondence to: Dr Prashant Mahajan, CS Mott Children's Hospital, University of Michigan 1540 East Hospital drive, Room 2-737, SPC 4260, Ann Arbor, MI 48109-4260, USA.

出版信息

Indian Pediatr. 2017 Aug 15;54(8):652-660. doi: 10.1007/s13312-017-1129-8. Epub 2017 Jun 4.

DOI:10.1007/s13312-017-1129-8

PMID:28607213

Abstract

JUSTIFICATION

India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child.

PROCESS

We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm.

OBJECTIVE

To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards.

RECOMMENDATIONS

We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.

摘要

理由

印度拥有近15亿人口，需要一种针对该国国情、基于证据且达成共识的方法，用于急诊科对发热儿童的评估与管理。

过程

我们召开了两次共识会议，进行了详尽的文献综述，并持续开展基于网络的讨论，以就提议的评估与管理算法达成正式共识。第一次会议于2015年10月在德里举行，由印度急诊专家学术学院（ACEE - INDIA）的儿科急诊医学（PEM）部门主持；第二次会议于2016年3月在浦那举行的急诊医学儿科学与最新趋势（EMPART 2016）期间召开。第二次会议之后，又通过基于电子邮件的进一步讨论，就提议的算法达成正式共识。

目的

制定一种用于评估与管理发热儿童的算法方法，该方法能够在急诊护理环境中轻松应用，并可根据当地流行病学和实践标准进行修改。

建议

我们创建了一种算法，可协助临床医生对前往急诊科的发热儿童进行评估与管理，并结合印度的医疗保健情况。本指南包括以下关键组成部分：分诊与及时评估；评估；以及患儿从急诊科的处置。我们敦促开发并创建一个包含最低标准数据元素的强大数据库。这将提供对护理过程和患者结局的系统测量，并更好地了解印度发热疾病的各种病因；这两者均可用于进一步修改提议的方法和算法。