Berends Esmée A, Erasmus Elaine, van Veenendaal Nicole R, Mukonkole Suzan N, Lahri Sa'ad, Van Hoving Daniël J
Khayelitsha Hospital, Khayelitsha, Cape Town, South Africa.
Department of Paediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
Afr J Emerg Med. 2021 Mar;11(1):98-104. doi: 10.1016/j.afjem.2020.09.001. Epub 2020 Oct 5.
The provision of high-quality care is vital to improve child health and survival rates. A simple, practice-based tool was recently developed to evaluate the quality of paediatric emergency care in resource-limited settings in Africa. This study used the practice-based tool to describe the documented adherence to critical actions in paediatric emergency care at an urban district-level hospital in South Africa and assess its relation to clinical outcomes.
This study is a retrospective observational study covering a 19-month period (September 2017 to March 2019). Patients <13 years old, presenting to the emergency centre with one of six sentinel presentations (seizure, altered mental status, diarrhoea, fever, respiratory distress and polytrauma) were eligible for inclusion. In the patients' files, critical actions specific for each presentation were checked for completion. Post-hoc, a seventh group 'multiple diagnoses' was created for patients with more than one sentinel disease. The action completion rate was tested for association with clinical outcomes.
In total, 388 patients were included (median age 1.1 years, IQR 0.3-3.6). The action completion rate varied from 63% (polytrauma) to 90% (respiratory distress). Participants with ≥75% action completion rate were younger (p < 0.001), presented with high acuity (p < 0.001), were more likely to be admitted (adjusted OR 2.2, 95%CI: 1.2-4.1), and had a hospital stay ≥4 days (adjusted OR 3.4, 95%CI: 1.5-7.9).
A high completion rate was associated with young age, a high patient acuity, hospital admission, length of hospital stay ≥4 days, and the specific sentinel presentation. Future research should determine whether or not documented care corresponds with the quality of delivered care and the predictive value regarding clinical outcome.
提供高质量护理对于改善儿童健康状况和提高生存率至关重要。最近开发了一种基于实践的简单工具，用于评估非洲资源有限地区的儿科急诊护理质量。本研究使用该基于实践的工具来描述南非一家城市区级医院儿科急诊护理中记录的关键行动依从情况，并评估其与临床结局的关系。
本研究是一项回顾性观察性研究，涵盖19个月的时间段（2017年9月至2019年3月）。年龄<13岁、因六种哨点症状之一（癫痫发作、精神状态改变、腹泻、发热、呼吸窘迫和多发伤）前往急诊中心就诊的患者符合纳入标准。在患者病历中，检查每种症状特定的关键行动是否完成。事后，为患有不止一种哨点疾病的患者创建了第七组“多重诊断”。检验行动完成率与临床结局的相关性。
共纳入388例患者（中位年龄1.1岁，IQR 0.3 - 3.6）。行动完成率从63%（多发伤）到90%（呼吸窘迫）不等。行动完成率≥75%的参与者更年轻（p < 0.001），病情严重程度高（p < 0.001），更有可能入院（调整后OR 2.2，95%CI：1.2 - 4.1），且住院时间≥4天（调整后OR 3.4，95%CI：1.5 - 7.9）。
高完成率与年轻、患者病情严重程度高、入院、住院时间≥4天以及特定的哨点症状相关。未来的研究应确定记录的护理是否与提供的护理质量相符以及对临床结局的预测价值。
