From the AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.
ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne.
Pediatr Infect Dis J. 2021 Jul 1;40(7):674-680. doi: 10.1097/INF.0000000000003116.
Many ambulatory networks in several countries have established syndromic surveillance systems to detect outbreaks of different illnesses. Here, we describe a new Pediatric and Ambulatory Research in Infectious diseases network that combined automated data extraction from the computers of primary care pediatricians.
Pediatricians who used the same software, AxiSanté 5-Infansoft for electronic medical records were specially trained in infectious diseases, encouraged to comply with French treatments' recommendations, use of point-of-care tests and vaccination guidelines. Infectious disease diagnoses in children <16 years old in the records triggered automatic data extraction of complete records. A quality control process and external validation were developed.
From September 2017 to February 2020, 107 pediatricians enrolled 57,806 children (mean age 2.9 ± 2.6 years at diagnosis) with at least one infectious disease diagnosis among those followed by the network. Among the 118,193 diagnoses, the most frequent were acute otitis media (n = 44,924, 38.0%), tonsillopharyngitis (n = 13,334, 11.3%), gastroenteritis (n = 12,367, 10.5%), influenza (n = 11,062, 9.4%), bronchiolitis (n = 10,531, 8.9%), enteroviral infections (n = 8474, 7.2%) and chickenpox (n = 6857, 5.8%). A rapid diagnostic test was performed in 84.7% of cases of tonsillopharyngitis and was positive in 44%. The antibiotic recommendations from French guidelines were strictly followed: amoxicillin was the most prescribed antibiotic and less than 10% of presumed viral infections were treated.
This "tailor-made" network set up with quality controls and external validation represents a new approach to the surveillance of pediatric infectious diseases in the digital era and could highly optimize pediatric practices.
许多国家的门诊网络已经建立了综合征监测系统，以检测不同疾病的爆发。在这里，我们描述了一个新的儿科和门诊传染病研究网络，该网络结合了从初级保健儿科医生的计算机中自动提取数据。
专门培训使用相同软件（AxiSanté 5-Infansoft 电子病历）的儿科医生了解传染病，鼓励他们遵守法国治疗建议、使用即时检测和疫苗接种指南。记录中 16 岁以下儿童的传染病诊断会触发完整记录的自动数据提取。制定了质量控制流程和外部验证。
从 2017 年 9 月至 2020 年 2 月，107 名儿科医生招募了 57806 名儿童（诊断时的平均年龄为 2.9±2.6 岁），这些儿童是网络跟踪的对象。在 118193 例诊断中，最常见的是急性中耳炎（n=44924，38.0%）、扁桃体咽炎（n=13334，11.3%）、肠胃炎（n=12367，10.5%）、流感（n=11062，9.4%）、细支气管炎（n=10531，8.9%）、肠病毒感染（n=8474，7.2%）和水痘（n=6857，5.8%）。扁桃体咽炎病例中进行了快速诊断检测，阳性率为 44%。严格遵循法国指南的抗生素建议：最常开的抗生素是阿莫西林，不到 10%的疑似病毒感染得到治疗。
该“定制”网络设置了质量控制和外部验证，代表了数字时代儿科传染病监测的一种新方法，可极大优化儿科实践。
