Wong Ai-Lynn, Meehan Elaine, Babl Franz E, Reid Susan M, Catto-Smith Anthony, Williams Katrina, Reddihough Dinah S
Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.
Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2019 Oct;55(10):1230-1236. doi: 10.1111/jpc.14386. Epub 2019 Jan 30.
To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken.
The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes. Additional data on presentations were extracted from medical records.
Over 5 years, there were 234 ED presentations due to feeding tube-related complaints among a CP cohort (n = 2183). ED notes were located for 183 of the 234 presentations. The majority of presentations (90%) involved children with severe gross motor impairment. A total of 46% of presentations (n = 84) was triaged as lower urgency, and 68% (n = 124) took place between 08:00 am and 06:00 pm. The most common presenting complaint was tube dislodgement (n = 105; 70%). No investigations were recorded in the majority of cases, and in almost 90% of cases, the feeding tube was successfully replaced in the ED, usually by an ED physician (n = 74) and less frequently by a surgeon (n = 9), gastroenterologist (n = 2) or nurse (n = 8); 9% (n = 17) resulted in a hospital admission.
Most ED presentations due to feeding tube complaints in children with CP are in children with severe gross motor impairment but are able to be managed in the ED. As such, it is likely that care givers and other health professionals could manage some of the complications experienced in primary health-care settings closer to home.
描述脑瘫（CP）患儿因胃造口术或胃空肠喂养管并发症而到急诊科（ED）就诊的特征、并发症的复杂性以及所采取的管理方法。
将维多利亚州脑瘫登记册与维多利亚州两家三级儿科医院的急诊科数据库相链接，并根据出院诊断代码确定因喂养管并发症就诊的数据。从病历中提取就诊的其他数据。
在5年多的时间里，CP队列（n = 2183）中有234例因喂养管相关问题到急诊科就诊。在这234例就诊病例中，找到了183份急诊科记录。大多数就诊病例（90%）涉及严重粗大运动障碍的儿童。共有46%的就诊病例（n = 84）被分诊为低紧急程度，68%（n = 124）的就诊发生在上午8点至下午6点之间。最常见的就诊主诉是喂养管移位（n = 105；70%）。大多数病例未记录进行任何检查，在几乎90%的病例中，喂养管在急诊科成功更换，通常由急诊科医生（n = 74）进行，较少由外科医生（n = 9）、胃肠病学家（n = 2）或护士（n = 8）进行；9%（n = 17）的病例导致住院。
CP患儿因喂养管问题到急诊科就诊的大多数病例是严重粗大运动障碍的儿童，但能够在急诊科得到处理。因此，护理人员和其他卫生专业人员很可能可以处理一些在离家较近的初级卫生保健环境中出现的并发症。
