Prehosp Emerg Care. 2019 Jul-Aug;23(4):491-500. doi: 10.1080/10903127.2018.1539147. Epub 2019 Jan 2.
To inform the future development of a pediatric prehospital sepsis tool, we sought to 1) describe the characteristics, emergent care, and outcomes for children with septic shock who are transported by emergency medicine services (EMS) and compare them to those self-transported; and 2) determine the EMS capture rate of common sepsis screening parameters and the concordance between the parameters documented in the EMS record and in the emergency department (ED) record. This is a retrospective cohort study of children ages 0 through 21 years who presented to a pediatric ED with septic shock between 11/2013 and 06/2016. Data, collected by electronic and manual chart review of EMS and ED records, included demographics, initial vital signs in both EMS and ED records, ED triage level, site of initial ED care, ED disposition, ED therapeutic interventions, outcomes, and times associated with processes. Potential screening parameters were dichotomized as normal vs. abnormal based on age-dependent normative data. : Of the children with septic shock treated in our ED, 19.3% arrived via EMS. These children as compared to those self-transported were more likely (i.e., p < 0.05) to be male, have public insurance, receive initial care in the ED resuscitation suite, be hypotensive on arrival, receive their first ED fluid bolus sooner (33 vs. 58 minutes), receive vasoactive agents, be mechanically ventilated in the first 24 hours, and have slightly longer length of hospital stays. Both groups had similar times to antibiotics. While poor outcomes were rare, the 3- and 30-day mortalities were similar for both groups. EMS capture rates were highest for heart rate and respiratory rate and lowest for temperature, glucose, and blood pressure. Interrater reliability was highest for heart rate. Children presenting to the ED with septic shock transported by EMS represent a critically ill subset of modest proportions. Realization of a sepsis screening tool for this vulnerable population will require both creation of a tool containing a limited subset of objective parameters along with processes to ensure capture.
为了为儿科院前脓毒症工具的未来发展提供信息，我们旨在：1）描述由急诊医学服务（EMS）转运的脓毒性休克儿童的特征、紧急护理和结局，并将其与自行转运的儿童进行比较；2）确定 EMS 对常见脓毒症筛查参数的捕获率以及 EMS 记录和急诊科（ED）记录中记录的参数之间的一致性。这是一项回顾性队列研究，纳入了 2013 年 11 月至 2016 年 6 月期间因脓毒性休克到儿科 ED 就诊的 0 至 21 岁儿童。数据通过电子和手动图表回顾 EMS 和 ED 记录收集，包括人口统计学数据、EMS 和 ED 记录中初始生命体征、ED 分诊级别、初始 ED 治疗地点、ED 处置、ED 治疗干预、结局以及与过程相关的时间。潜在的筛查参数根据年龄依赖性正常范围数据分为正常和异常。在我们 ED 接受治疗的脓毒性休克患儿中，19.3%通过 EMS 到达。与自行转运的患儿相比，这些患儿更有可能（即 p < 0.05）为男性、有公共保险、在 ED 复苏室接受初始治疗、到达时低血压、更早接受首次 ED 液体冲击（33 分钟对 58 分钟）、接受血管活性药物、24 小时内机械通气以及住院时间略长。两组患儿接受抗生素的时间相似。尽管预后不良的情况很少，但两组患儿的 3 天和 30 天死亡率相似。EMS 的捕获率最高的参数为心率和呼吸频率，最低的参数为体温、血糖和血压。心率的观察者间可靠性最高。由 EMS 转运到 ED 的脓毒性休克患儿代表了比例适中的危重症亚群。为这一脆弱人群开发脓毒症筛查工具需要创建一个包含有限客观参数的工具，并确保其捕获率。
