儿童溺水评分可预测溺水后受伤风险低的儿童。
The Pediatric Submersion Score Predicts Children at Low Risk for Injury Following Submersions.
作者信息
Shenoi Rohit P, Allahabadi Sachin, Rubalcava Daniel M, Camp Elizabeth A
机构信息
Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Department of Orthopedic Surgery, University of California, San Francisco, CA.
出版信息
Acad Emerg Med. 2017 Dec;24(12):1491-1500. doi: 10.1111/acem.13278. Epub 2017 Sep 23.
OBJECTIVES
Pediatric submersion victims often require admission. We wanted to identify a cohort of children at low risk for submersion-related injury who can be safely discharged from the emergency department (ED) after a period of observation.
METHODS
This was a single-center retrospective derivation/validation cross-sectional study of children (0-18 years) who presented postsubmersion to a tertiary care, children's hospital ED from 2008 to 2015. We reviewed demographics, comorbidities, and prehospital and ED course. Primary outcome was safe discharge at 8 hours postsubmersion: normal mentation and vital signs. To identify potential scoring factors, any p-value of ≤0.25 was included in binary logistic regression; p-values < 0.05 were included in the final score. In the validation data set, we generated a one-point scoring system for each normal ED item. Receiver operating characteristic curves with area under the curve (AUC) were generated to test sensitivity and specificity.
RESULTS
The derivation data set consisted of 356 patients and validation data set of 89 patients. Five factors generated a safe discharge score at 8 hours: normal ED mentation, normal ED respiratory rate, absence of ED dyspnea, absence of need for airway support (bag-valve mask ventilation, intubation, and CPAP), absence of ED systolic hypotension (maximum score = 5; range = 0-5). Only the 80 patients with values for all five factors were included in the sensitivity/specificity analysis. This resulted in an AUC of 0.81 (95% confidence interval [CI] = 0.71-0.91; p < 0.001). Based on the sensitivity/specificity analysis, the discriminative ability peaks at 75% with a score of ≥3.5. A score of 4 or higher in the ED would suggest a safe discharge at 8 hours (sensitivity = 88.2% [95% CI = 72.5%-96.7%]; specificity = 62.9% [95% CI = 44.9%-78.5%]; positive predictive value = 69.8% [95% CI = 53.9%-82.8%]; negative predictive value = 84.6% [95% CI = 65.1%-95.6%]).
CONCLUSIONS
A risk score can identify children at low risk for submersion-related injury who can be safely discharged from the ED after observation.
目的
小儿溺水受害者通常需要住院治疗。我们希望确定一组溺水相关损伤低风险儿童，他们在经过一段时间观察后可从急诊科（ED）安全出院。
方法
这是一项单中心回顾性推导/验证横断面研究，研究对象为2008年至2015年因溺水后到一家三级医疗儿童医院急诊科就诊的0至18岁儿童。我们回顾了人口统计学、合并症以及院前和急诊科病程。主要结局是溺水后8小时安全出院：精神状态和生命体征正常。为确定潜在的评分因素，二元逻辑回归纳入任何p值≤0.25的因素；最终评分纳入p值<0.05的因素。在验证数据集中，我们为每个正常的急诊科项目生成一个一分制评分系统。生成带有曲线下面积（AUC）的受试者工作特征曲线以测试敏感性和特异性。
结果
推导数据集包括356例患者，验证数据集包括89例患者。五个因素可得出溺水后8小时的安全出院评分：急诊科精神状态正常、急诊科呼吸频率正常、无急诊科呼吸困难、无需气道支持（气囊面罩通气、插管和持续气道正压通气）、无急诊科收缩期低血压（最高分=5分；范围=0 - 5分）。敏感性/特异性分析仅纳入了所有五个因素值均有的80例患者。这得出AUC为0.81（95%置信区间[CI]=0.71 - 0.91；p<0.001）。基于敏感性/特异性分析，评分≥3.5分时鉴别能力在75%达到峰值。急诊科评分4分或更高提示溺水后8小时可安全出院（敏感性=88.2%[95%CI=72.5% - 96.7%]；特异性=62.9%[95%CI=44.9% - 78.5%]；阳性预测值=69.8%[95%CI=53.9% - 82.8%]；阴性预测值=84.6%[95%CI=65.1% - 95.
Zotero 插件