Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Vic, Australia.
Clinical Sciences, Murdoch Children's Research Institute, Parkville, Vic, Australia.
Acta Paediatr. 2021 Mar;110(3):1046-1055. doi: 10.1111/apa.15602. Epub 2020 Oct 15.
To evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department.
Retrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6-month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra-corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver-operating characteristics curve were calculated for each predictor variable.
Between Jan-June 2019, 6217 children met inclusion criteria. Twenty-seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra-corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency.
Poor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.
评估急诊科发热儿童不良结局的发生频率及预测因素。
这是一项来自澳大利亚墨尔本皇家儿童医院急诊科的回顾性观察性研究。在 6 个月的时间内，所有以发热或分诊体温>38°C 为主要就诊原因的患儿均被纳入研究。不良结局定义为：新发器官功能障碍或需要器官支持治疗（血管活性药物输注、机械通气、肾脏替代治疗和体外生命支持）。评估的预测因素如下：初始生命体征、血液检查和临床评分。计算了每个预测变量的比值比、敏感性、特异性和受试者工作特征曲线下面积。
2019 年 1 月至 6 月期间，共有 6217 名患儿符合纳入标准。27 名（0.4%）患儿出现新发器官功能障碍，10 名（0.2%）患儿需要器官支持治疗（血管活性药物输注 5 例，机械通气 6 例，肾脏替代治疗 1 例，体外生命支持 1 例）。初始生命体征、血液检查和临床评分异常的患儿发生新发器官功能障碍、需要血管活性药物支持和机械通气的可能性更高，但由于不良结局发生率较低，整体检测特征较差。
急诊科发热儿童的不良结局并不常见。生命体征、血液检查和临床评分预测不良结局的效果不佳。
