Division of Pediatric Emergency, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
Division of Pediatric Emergency, Department of Pediatrics,Tepecik Teaching and Research Hospital, İzmir, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
Turk J Pediatr. 2021;63(1):59-67. doi: 10.24953/turkjped.2021.01.007.
The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated.
This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed.
During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p < 0.001). Most procedures were performed on children aged one or older (p < 0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p < 0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics.
This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.
危重病儿童（CIC）护理中最不发达的领域是院前阶段。对该人群进行适当的院前评估和救生干预（LSI）具有挑战性，需要专门的资源来确保最佳结果。我们旨在确定送往土耳其儿科急诊部（ED）的 CIC 的特征和结果。还调查了院前提供者在途中和 ED 进行的 LSI 的频率和分布。
这项前瞻性研究于 2014 年 8 月至 2015 年 8 月在 4 个大都市和 9 个三级儿科 ED 进行。一项基于调查的研究评估了所有通过救护车送往参与 ED 的 CIC。CIC 定义为因任何原因需要 LSI 或需要重症监护入院的患者。寻求患者人口统计学，临床特征，转运原因，在救护车或 ED 中进行的程序。最后，分析了转运 CIC 的短期结果和转运相关风险。
在研究期间，共有 2094 名儿童通过救护车送往所有参与的 ED。其中只有 227 人（10.8％）病重。如果配备护理人员，紧急医疗服务（EMS）提供者在 CIC 中进行的程序较少（p <0.001）。大多数程序都是针对一岁或一岁以上的儿童进行的（p <0.001）。在将近四分之一的在 ED 接受 LSI 的患者中，在救护车中未进行任何程序。如果 EMS 没有医生，则院前提供者不太可能立即提供 LSI（p <0.001）。CIC 更有可能从二级/三级保健医院转来。如果救护车只有护理人员，短期死亡率更高。
这项研究表明，土耳其院前儿科急救护理不足。我们提供儿科急救的临床概述，以帮助 EMS 主任，政策制定者和 ED 主任为 CIC 提供护理。
