Gardner Alison, Fraile Katherine, Shirk Arianna
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Pediatric Emergency Medicine, AIC Kijabe Hospital, Kijabe, Kenya.
Afr J Emerg Med. 2020 Dec;10(4):224-228. doi: 10.1016/j.afjem.2020.07.012. Epub 2020 Aug 13.
Three decades ago, in North America, pediatric emergency medicine was an evolving subspecialty of pediatrics, contributing in valuable and life-saving ways to the care of children. Currently, in LMICs (low middle-income countries) pediatric programs are expanding training and education in the subspecialty of pediatric emergency medicine. We aim to determine if care provided by a single institution with dedicated pediatric emergency resources and personnel in Kenya can change mortality rates in children with similar mRISC scores suffering from respiratory illness, as compared to previously published data from the same region of Eastern Africa. As mRISC is used at the time of a child's admission to the hospital to describe the severity of their respiratory illness, we will compare mortality rates by mRISC score to compare groups of patients with similar severities of illness between hospitals.
A retrospective chart review was performed using written medical records of pediatric patients 30 days to 5 years of age admitted to AIC Kijabe Hospital, Kenya from 2014 to 2018 for respiratory illness. Of 2692 possible admissions identified in the hospital's pediatric database, 377 admissions were included. 34 data points were recorded for each patient admission including demographic information, information involved in calculating the mRISC score, and additional respiratory information. The primary outcomes were mRISC score and mortality.
20 (5%) of included patients represented in-hospital mortalities. Across all mRISC scores, our mortality remained much lower than previously reported in the literature in Kenya.
Our study does support a positive correlation between pediatric emergency medicine training and skills and decreased childhood mortality; however, correlation does not prove causation. How this decrease in mortality was accomplished was likely a combination of many smaller efforts at quality improvement that add up and make a difference as pediatricians are known to be child advocates.
三十年前，在北美，儿科急诊医学是儿科不断发展的亚专业，以宝贵且挽救生命的方式为儿童护理做出贡献。目前，在中低收入国家（LMICs），儿科项目正在扩大儿科急诊医学亚专业的培训和教育。我们旨在确定，与东非同一地区先前公布的数据相比，肯尼亚一家拥有专门儿科急诊资源和人员的单一机构所提供的护理，能否改变患有类似mRISC评分的呼吸道疾病儿童的死亡率。由于mRISC在儿童入院时用于描述其呼吸道疾病的严重程度，我们将按mRISC评分比较死亡率，以比较不同医院中病情严重程度相似的患者群体。
对2014年至2018年因呼吸道疾病入住肯尼亚AIC基贾贝医院的30天至5岁儿科患者的书面病历进行回顾性图表审查。在医院儿科数据库中确定的2692例可能的入院病例中，纳入了377例。为每例患者入院记录34个数据点，包括人口统计学信息、计算mRISC评分所涉及的信息以及其他呼吸道信息。主要结果是mRISC评分和死亡率。
纳入的患者中有20例（5%）在医院死亡。在所有mRISC评分中，我们的死亡率仍远低于肯尼亚此前文献报道的水平。
我们的研究确实支持儿科急诊医学培训和技能与儿童死亡率降低之间存在正相关；然而，相关性并不证明因果关系。死亡率的这种下降很可能是许多较小的质量改进努力共同作用的结果，这些努力加起来产生了影响，因为众所周知儿科医生是儿童权益的倡导者。
