坦桑尼亚一家三级医院急诊科儿童腹痛的负担与结局：一项描述性队列研究

The Burden and Outcomes of Abdominal Pain among Children Presenting to an Emergency Department of a Tertiary Hospital in Tanzania: A Descriptive Cohort Study.

作者信息

Sakita Francis M, Sawe Hendry R, Mwafongo Victor, Mfinanga Juma A, Runyon Michael S, Murray Brittany L

机构信息

Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.

Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.

出版信息

Emerg Med Int. 2018 May 9;2018:3982648. doi: 10.1155/2018/3982648. eCollection 2018.

DOI:10.1155/2018/3982648

PMID:29862079

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5971299/

Abstract

BACKGROUND

Abdominal pain in children can represent benign conditions or life-threatening emergencies. Aetiologies of paediatric abdominal pain vary geographically and have not been studied in acute care settings in East Africa. This study describes the clinical profiles and outcomes of children presenting with undifferentiated abdominal pain to the Emergency Department of Muhimbili National Hospital (ED-MNH).

METHODS

This was a prospective cohort study of children below 18 years of age presenting to the ED-MNH with abdominal pain. A structured case report form was used to collect data on patients from June to December 2016. Data included demographics, clinical presentation, and mortality. Data were summarised using descriptive statistics.

RESULTS

Out of 1855 children who presented to ED-MNH, 184 (9.9%) met inclusion criteria, and all were enrolled. The median age was 3.5 years (IQR: 1.3-7.0 years) and 124 (67.4%) were male. Most (138 [75.0%]) were referred from peripheral hospitals. The most frequent ED providers' diagnoses were hernia (34 [18.5%]) and intra-abdominal malignancy (19 [10.3%]). From the ED, 37 (20.1%) were discharged home, 83 (45.1%) were admitted to medical wards, and 48 (26.1%) were admitted to surgical wards. 16 (8.7%) underwent an operation. 24-hour, seven-day, and three-month mortality rates were 1.1%, 6.5%, and 14.5%, respectively. The overall in-hospital mortality rate was 12.2%. Multivariate analysis showed that age below 5 years, female sex, and haemoglobin less than 10.9 g/dl were significant factors associated with in-hospital mortality.

DISCUSSION AND CONCLUSION

Abdominal pain is a common complaint among paediatric patients presenting to the ED-MNH. This presentation was associated with a high admission rate and a high mortality rate. Age below 5 years, female sex, and haemoglobin less than 10.9 g/dl were associated with mortality. Further studies and quality improvement efforts should focus on identifying aetiologies, risk stratification, and appropriate interventions to optimise patients outcomes.

摘要

背景

儿童腹痛可能是良性病症，也可能是危及生命的紧急情况。小儿腹痛的病因因地域而异，在东非的急性护理环境中尚未进行过研究。本研究描述了在穆希姆比利国家医院急诊科（ED-MNH）就诊的不明原因腹痛儿童的临床特征和结局。

方法

这是一项对18岁以下因腹痛到ED-MNH就诊儿童的前瞻性队列研究。使用结构化病例报告表收集2016年6月至12月患者的数据。数据包括人口统计学、临床表现和死亡率。数据使用描述性统计进行汇总。

结果

在到ED-MNH就诊的1855名儿童中，184名（9.9%）符合纳入标准，全部入组。中位年龄为3.5岁（四分位间距：1.3 - 7.0岁），124名（67.4%）为男性。大多数（138名[75.0%]）是从周边医院转诊而来。急诊科医生最常做出的诊断是疝气（34名[18.5%]）和腹内恶性肿瘤（19名[10.3%]）。在急诊科，37名（20.1%）出院回家，83名（45.1%）入住内科病房，48名（26.1%）入住外科病房。16名（8.7%）接受了手术。24小时、7天和3个月的死亡率分别为1.1%、6.5%和14.5%。总体住院死亡率为12.2%。多变量分析显示，5岁以下、女性以及血红蛋白低于10.9 g/dl是与住院死亡率相关的重要因素。