智能分诊：使用即时儿科快速脓毒症触发工具（PRST）对儿童脓毒症进行分诊和管理。
Smart triage: triage and management of sepsis in children using the point-of-care Pediatric Rapid Sepsis Trigger (PRST) tool.
机构信息
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 217-2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
出版信息
BMC Health Serv Res. 2020 Jun 3;20(1):493. doi: 10.1186/s12913-020-05344-w.
BACKGROUND
Sepsis is the leading cause of death and disability in children. Every hour of delay in treatment is associated with an escalating risk of morbidity and mortality. The burden of sepsis is greatest in low- and middle-income countries where timely treatment may not occur due to delays in diagnosis and prioritization of critically ill children. To circumvent these challenges, we propose the development and clinical evaluation of a digital triage tool that will identify high risk children and reduce time to treatment. We will also implement and clinically validate a Radio-Frequency Identification system to automate tracking of patients. The mobile platform (mobile device and dashboard) and automated patient tracking system will create a low cost, highly scalable solution for critically ill children, including those with sepsis.
METHODS
This is pre-post intervention study consisting of three phases. Phase I will be a baseline period where data is collected on key predictors and outcomes before implementation of the digital triage tool. In Phase I, there will be no changes to healthcare delivery processes in place at the study hospitals. Phase II will involve model derivation, technology development, and usability testing. Phase III will be the intervention period where data is collected on key predictors and outcomes after implementation of the digital triage tool. The primary outcome, time to treatment initiation, will be compared to assess effectiveness of the digital health intervention.
DISCUSSION
Smart technology has the potential to overcome the barrier of limited clinical expertise in the identification of the child at risk. This mobile health platform, with sensors and data-driven applications, will provide real-time individualized risk prediction to rapidly triage patients and facilitate timely access to life-saving treatments for children in low- and middle-income countries, where specialists are not regularly available and deaths from sepsis are common.
TRIAL REGISTRATION
Clinical Trials.gov Identifier: NCT04304235, Registered 11 March 2020.
背景
败血症是导致儿童死亡和残疾的主要原因。每延误一小时治疗，发病率和死亡率的风险就会增加。败血症的负担在中低收入国家最大，由于诊断和优先考虑重症儿童方面的延迟，可能无法及时进行治疗。为了克服这些挑战，我们提出开发和临床评估数字分诊工具，以识别高风险儿童并减少治疗时间。我们还将实施并临床验证射频识别系统，以实现患者的自动跟踪。移动平台（移动设备和仪表板）和自动化患者跟踪系统将为包括败血症儿童在内的重症儿童创建一个低成本、高可扩展性的解决方案。
方法
这是一项干预前后研究，包括三个阶段。第 I 阶段是基线期，在此期间在实施数字分诊工具之前收集关键预测指标和结果的数据。在第 I 阶段，研究医院的医疗服务提供流程不会发生任何变化。第 II 阶段将涉及模型推导、技术开发和可用性测试。第 III 阶段是干预期，在此期间收集实施数字分诊工具后关键预测指标和结果的数据。主要结果，即开始治疗的时间，将进行比较，以评估数字健康干预的效果。
讨论
智能技术有可能克服识别高危儿童的临床专业知识有限的障碍。这个带有传感器和数据驱动应用程序的移动健康平台将提供实时的个体化风险预测，以便快速对患者进行分诊，并为中低收入国家的儿童提供及时获得救命治疗的机会，在这些国家，专家并不常见，败血症导致的死亡很常见。
试验注册
ClinicalTrials.gov 标识符：NCT04304235，注册于 2020 年 3 月 11 日。
Zotero 插件