Nielsen Katie R, Aronés Rojas Rubén, Tantaleán da Fieno José, Huicho Luis, Roberts Joan S, Zunt Joseph
Department of Pediatrics Critical Care Medicine, University of Washington, Seattle, Washington, United States.
Department of Global Health, University of Washington, Seattle, Washington, United States.
J Paediatr Child Health. 2018 Aug;54(8):866-871. doi: 10.1111/jpc.13904. Epub 2018 Mar 26.
Identification of critically ill children upon presentation to the emergency department (ED) is challenging, especially when resources are limited. The objective of this study was to identify ED risk factors associated with serious clinical deterioration (SCD) during hospitalisation in a resource-limited setting.
A retrospective case-control study of children less than 18 years of age presenting to the ED in a large, freestanding children's hospital in Peru was performed. Cases had SCD during the first 7 days of hospitalisation whereas controls did not. Information collected during initial ED evaluation was used to identify risk factors for SCD.
A total of 120 cases and 974 controls were included. In univariate analysis, young age, residence outside Lima, evaluation at another facility prior to ED presentation, congenital malformations, abnormal neurologic baseline, co-morbidities and a prior paediatric intensive care unit admission were associated with SCD. In multivariate analysis, age < 12 months, residence outside Lima and evaluation at another facility prior to ED presentation remained associated with SCD. In addition, comatose neurological status, hypoxaemia, tachycardia, tachypnoea and temperature were also associated with SCD.
Many risk factors for SCD during hospitalisation can be identified upon presentation to the ED. Using these factors to adjust monitoring during and after the ED stay has the potential to decrease SCD events. Further studies are needed to determine whether this holds true in other resource-limited settings.
在急诊部门（ED）识别危重症儿童具有挑战性，尤其是在资源有限的情况下。本研究的目的是确定在资源有限的环境中，与住院期间严重临床恶化（SCD）相关的急诊风险因素。
对秘鲁一家大型独立儿童医院急诊科收治的18岁以下儿童进行了一项回顾性病例对照研究。病例在住院的前7天出现SCD，而对照则未出现。在最初的急诊评估期间收集的信息用于确定SCD的风险因素。
共纳入120例病例和974例对照。在单因素分析中，年龄小、居住在利马以外地区、在急诊就诊前在其他机构进行过评估、先天性畸形、异常的神经学基线、合并症以及既往入住过儿科重症监护病房与SCD相关。在多因素分析中，年龄<12个月、居住在利马以外地区以及在急诊就诊前在其他机构进行过评估仍与SCD相关。此外，昏迷的神经状态、低氧血症、心动过速、呼吸急促和体温也与SCD相关。
在急诊就诊时可以识别出许多住院期间SCD的风险因素。利用这些因素在急诊停留期间及之后调整监测有可能减少SCD事件。需要进一步研究以确定在其他资源有限的环境中是否也是如此。
