Praveen Kumar, Nallasamy Karthi, Jayashree Muralidharan, Kumar Praveen
Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
BMJ Paediatr Open. 2020 Feb 12;4(1):e000606. doi: 10.1136/bmjpo-2019-000606. eCollection 2020.
Brought in dead (BID) presentation is profoundly related to prehospital variables including disease-related determinants and social and system-related factors. Identifying these factors would help us recognise various gaps in health services.
Tertiary paediatric emergency department (ED) in north India.
Children aged 12 years or younger presented in cardiac arrest between April 2016 and March 2017 were prospectively enrolled irrespective of outcome of cardiopulmonary resuscitation (CPR). Data were collected from multiple sources including referral documents, direct interview from parents and field observations at the referring facility.
Of 100 BID cases enrolled, 55 were neonates. Low birth weight (n=43, 78%) and malnutrition (n=31, 69%) were respectively common in neonates and postneonatal children. The most frequent symptom was breathing difficulty (n=80). Common diagnoses included respiratory distress syndrome (n=21, 38%), birth asphyxia (n=19, 35%) and sepsis (n=11, 20%) in neonates, and pneumonia (n=11, 25%), congenital heart disease (n=6, 13%) and acute gastroenteritis (n=5, 11%) in postneonatal children. Eighty-nine cases were referred from another healthcare facility, majority after first healthcare contact (n=77, 87%). Progressive severity of illness (n=61, 71%) and lack of expertise for acute care (n=35, 39%) were the common reasons for referral. Ambulance (n=77) was the most common mode of transport; median (IQR) distance and duration of travel were 80 (25-111.5) km and 120 (60-180) min, respectively. Respiratory support during transport included supplemental nasal oxygen (n=41, 46%) and bag and tube ventilation (n=30, 34%). Clinical deterioration was recognised in 62 children during transport, only five received CPR en route. Ninety-five children underwent CPR at the referral centre, two had return of spontaneous circulation.
Social and system-related factors contribute to children presenting to ED in BID state. Streamlining the referral process and linking transport to hospital care could reduce decompensated referrals and thereby decrease child mortality.
送达时已死亡（BID）的情况与院前因素密切相关，包括疾病相关决定因素以及社会和系统相关因素。识别这些因素将有助于我们认识到卫生服务中的各种差距。
印度北部的三级儿科急诊科。
前瞻性纳入2016年4月至2017年3月期间出现心脏骤停的12岁及以下儿童，无论心肺复苏（CPR）结果如何。数据从多个来源收集，包括转诊文件、对家长的直接访谈以及在转诊机构的现场观察。
在纳入的100例BID病例中，55例为新生儿。低出生体重（n = 43，78%）和营养不良（n = 31，69%）分别在新生儿和新生儿后期儿童中常见。最常见的症状是呼吸困难（n = 80）。常见诊断包括新生儿呼吸窘迫综合征（n = 21，38%）、出生窒息（n = 19，35%）和败血症（n = 11，20%），以及新生儿后期儿童的肺炎（n = 11，25%）、先天性心脏病（n = 6，13%）和急性胃肠炎（n = 5，11%）。89例从另一家医疗机构转诊，大多数在首次医疗接触后（n = 77，87%）。疾病进行性加重（n = 61，71%）和缺乏急性护理专业知识（n = 35，39%）是转诊的常见原因。救护车（n = 77）是最常见的运输方式；中位（IQR）距离和行程时间分别为80（25 - 111.5）km和120（60 - 180）分钟。运输过程中的呼吸支持包括补充鼻导管给氧（n = 41，46%）和面罩球囊通气（n = 30，34%）。62名儿童在运输过程中出现临床恶化，仅5名在途中接受了心肺复苏。95名儿童在转诊中心接受了心肺复苏，2名恢复自主循环。
社会和系统相关因素导致儿童以BID状态就诊于急诊科。简化转诊流程并将运输与医院护理相联系可减少失代偿性转诊，从而降低儿童死亡率。
