Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America.
Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45249, United States of America.
Am J Emerg Med. 2021 Sep;47:217-222. doi: 10.1016/j.ajem.2021.04.053. Epub 2021 Apr 21.
To determine if differences in patient characteristics, treatments, and outcomes exist between children with sepsis who arrive by emergency medical services (EMS) versus their own mode of transport (self-transport).
Retrospective cohort study of patients who presented to the Emergency Department (ED) of two large children's hospitals and treated for sepsis from November 2013 to June 2017. Presentation, ED treatment, and outcomes, primarily time to first bolus and first parental antibiotic, were compared between those transported via EMS versus patients who were self-transported.
Of the 1813 children treated in the ED for sepsis, 1452 were self-transported and 361 were transported via EMS. The EMS group were more frequently male, of black race, and publicly insured than the self-transport group. The EMS group was more likely to have a critical triage category, receive initial care in the resuscitation suite (51.9 vs. 22%), have hypotension at ED presentation (14.4 vs. 5.4%), lactate >2.0 mmol/L (60.6 vs. 40.8%), vasoactive agents initiated in the ED (8.9 vs. 4.9%), and to be intubated in the ED (14.4 vs. 2.8%). The median time to first IV fluid bolus was faster in the EMS group (36 vs. 57 min). Using Cox LASSO to adjust for potential covariates, time to fluids remained faster for the EMS group (HR 1.26, 95% CI 1.12, 1.42). Time to antibiotics, ICU LOS, 3- or 30-day mortality rates did not differ, yet median hospital LOS was significantly longer in those transported by EMS versus self-transported (6.5 vs. 5.3 days).
Children with sepsis transported by EMS are a sicker population of children than those self-transported on arrival and had longer hospital stays. EMS transport was associated with earlier in-hospital fluid resuscitation but no difference in time to first antibiotic. Improved prehospital recognition and care is needed to promote adherence to both prehospital and hospital-based sepsis resuscitation benchmarks.
确定通过紧急医疗服务（EMS）到达的与自行到达的脓毒症患儿在患者特征、治疗和结局方面是否存在差异。
回顾性队列研究纳入 2013 年 11 月至 2017 年 6 月期间在两家大型儿童医院急诊科就诊并接受脓毒症治疗的患者。比较通过 EMS 转运的患者与自行转运的患者在就诊时、急诊科治疗和结局方面的差异，主要结局指标为首次输液和首次给予父母抗生素的时间。
在急诊科接受脓毒症治疗的 1813 例患儿中，1452 例为自行转运，361 例为通过 EMS 转运。与自行转运组相比，EMS 转运组患儿更常为男性、黑种人、公共保险。EMS 转运组更可能分诊为危急类别，在复苏室接受初始治疗（51.9%比 22%），在急诊科就诊时血压低（14.4%比 5.4%），血乳酸>2.0mmol/L（60.6%比 40.8%），在急诊科开始使用血管活性药物（8.9%比 4.9%），在急诊科插管（14.4%比 2.8%）。EMS 转运组首次静脉输液的中位时间更快（36 分钟比 57 分钟）。使用 COX LASSO 调整潜在协变量后，EMS 组输液时间仍然更快（HR 1.26，95%CI 1.12，1.42）。抗生素使用时间、ICU 住院时间、3 天或 30 天死亡率无差异，但与自行转运相比，EMS 转运组的中位住院时间明显更长（6.5 天比 5.3 天）。
与自行到达的脓毒症患儿相比，通过 EMS 转运的患儿病情更重，住院时间更长。EMS 转运与院内早期液体复苏有关，但与首次使用抗生素的时间无差异。需要改善院前识别和治疗，以促进遵守基于院前和院内的脓毒症复苏基准。
